Vietnann Journal of Physiology 17(1), 4/2013 ISSN: 1 8 5 9 - 2 3 7 6
Correlation between location of the accessory pathways and surface ECG parameters in typical W o l f f - Parkinson -
White syndrome patients Chu Dung S l \ Phan Dinh Phong^
Pham Quoc Kha^h^ Trinh Hoang Ha^
^School of IVIedicine and Pharmacy, Vietnam National University, Hanoi 'National Heart Institute, Bach Mai hospital Received Mar. 26, 2013; revised Apr. 5, 2013; accepted Apr. 25, 2013 In order to compare the position of accessory pathways to the surface ECG parameters in patients with Wotff-Parkinson- White (WPW) syndrome, a study had been carried out on 135 patients with a typical WPW syndrome at Vietnam Heart Institute.
Bach Mai Hospital The surface ECG parameters were compared with the position of accessory pathways identified as described above and radio frequency (RF) treatment.
We found that PR interval in the left group was 112.6 ± 11.5 ms. It was longer than that In the right group (102.4 ± 15.8 ms) (p < 0.05).
A similar result was obsen/ed with QRS duration. QRS duration was 134.1 ± 16.7 ms
in the left group vs. 146.9 ± 23.6 ms in the right group (p < 0.05). Negative delta wave in VI found in 90.76% cases of the right group, while positive delta wave in V1 found in 97.14% cases of the leff group. The positive delta waves in at least 2/3 inferior leads of the common in the anterior accessory pathway of the atnoventricular vales occurred in 79.7% of cases, while the negative delta waves in at least 2/3 inferior leads of the common In the posterior accessory pathway of the atrioventricular valve accounted for 93.94% of cases. For the right suthpathways (negative delta wave in VI). the transition of the QRS complex in VI, V2 met in 92.5% of the septal accessory pathways, while the QRS transition after V2 leads found In 92.2% of the free wall accessory pathways Therefore, the surface ECG parameters in typical WPW syndrome closely related to accessory pathways position during cardiac electrophysiological testing and can be used to predict the location accessory pathways.
Key words: position of accessory pathways, ECG, Wolff-Parkinson-White syndrome
MOT S 6 BAG fiieiW XET NGHIEM MAU Cf PHU NO' MANG THAI BA THANG C U 6 l TAI HA NQI
Phan Thj Minh Ngpc\ Le Thj HiSu^ Od Tiln Dung^
NguySn Tuin Tung', Vu VSn T^udng^ Phgm Phuang Thao\ Pham Quang Vinh^
^Dai hgc YHa Ngi 'Benh vien Phu San Hd Nol
^Benh vien Bach Mai Nh§n bai 25/10/2012; sua bai 26/10/2012; chap nh^n dang 7/11/2012 Myc tieu cue nghidn c&u ndy Id md td mOt s6 d$c didm td bdo mdu vd ddng mdu & phu nir mang thai ba thdng cudi. Ddi tuvng nhdm nghidn c&u: 60 phu nQ- cd thai t& 30 tuin tr& Idn fg/
Bdnh vi$n Phu sdn Hd Ndi. nhdm ch&ng: 20 pht^ n& khde manh tmng dd tudi sinh sdn. Cdc chf sd nghidn c&u gdm sd luvng tidu cdu, PT. APTT, Tibrinogen, s6 luvng hdng ciu. Hb, MCV.
fVlCH. MCHC, sd luvng b?ch cdu. Phuvng ti$n nghidn c&u gdm mdy ddm td bdo (y ddng XTIBOOi vd mdy ddng mdu CAI500 cua hdng Sysmex (Nhdt Bdn). Kdt qud nghidn c&u cho thiy sd luvng tidu ciu trung binh cOa nhdm nghidn c&u Id 197,33 ± 69.5 G/l, APTTs trung binh la
27,32 ± 1,42 giiy, rAPTT li 0.95 ± O.OS, PTs li 11,25 ± 0,54 giiy, PT% li 105,85 ± 14.88%,
PT-INR li 0,96 ± 0,26, ndng 6Q fibrinogen huySt tuvng li 3,90 ±0,47 g/l: nhdm c6 tu6i thai cing cao thi ndng 66 fibrinogen huy6t turnig cing cao. S6 luong hdng ciu li 4,02 ± 0,50 Tfi. ndng d^Hbli 119,20 ± 10,11 g/l, MCV 90.23 ± 8.40 H, MCH 29,92 ± 3,02 pg, MCHC 331,43 ±11,41 g/l, s6 lucmg b?ch ciu li 10,49 ± 2,60 G/l. Ngoii PT, cio ohls6 Mng miu aiu thay Mic6 f nghia thdng ki so vdri nhdm chOrtg, trong khi xit nghiim ti bio chua thiy s^r khic biit. If li thai phu thiiu miu li 35%.
TiFkhda: ti bio miu, ihai nghin 1. OAT VAN Dfi
Thai ngh6n li giar doan md Cff th^ ngu-d^i phy nQ' mang thai c6 s ^ bi4n (36i & nhlSu h$
th6ng, trong (36 c6 si,F thay (3di v6 miu. VI v$y tim hi^u ve bi6n doi huy^t hoc n6i chung vi afing, c^m miu n6i rieng trong san l<hoa dang la hu'o'ng nghien ci>u di^ffc quan tam hi$n nay.Iren the gii/i ai c6 nhi^u tic gia nghign ci>u die a i l m dang m^u ff phy n& co thai [5], [7], [8] (^ Vi$t nam cQng aa c6 mdt s6 tac gia nghian cu'u v i n d^ nay [1], [3], [8] Tuy nhlSn, chu'a c6 nghien cCru nao tap trung tim h i l u dac diem x6t nghiim mau cua ttrng giai doan mang thai l!hac nhau. NhSm gdp philn tim hilu v i n d l nay, chijng t6i t i l n hanh nghlSn CLTU nhSm myc tieu m6 ta mdt s6 dac d i l m cac t l bao mSu va ddng mau ff phu nO c6 thai ba thang c u l i tai Ha Npi.
2. B 6 | TUqiNG VA PHUONG P H A P NGHIEN CCfU
2.1. 061 tu'O'ng nghign cCi'u
- 60 phy no mang thai ba thang c u l i (tC 30 t u i n trd l§n) d i n IchSm thai dinh l<J tai B$nh vien Phy San Ha Ndi trong thang 9/2012, tlnh nguydn tham gia nghidn cii'u.
- 20 phg nd lihde manh trong dd t u l i smh de (15-49 tuli) nhu'ng l(hdng mang thai as duffc thu nhan vao nhdm chirng.
2.2. cac chi s i nghien ci>u
- S l lu-ffng hong c l u . bach c l u , Hb, MCV.
MCH, MCHC. s l lu-ffng t i l u cau, PT, APTT.
Fibrinogen.
2.3. Phu'cng ti^n nghien cu'u
May a i m t l bao t y ddng XT 18001, may ddng mau CA 1500 cua hang Sysmex (Nhat Ban).
2.4. Phu'O'ng phap nghidn ciJu - c a c d l i tuffng d i n l<ham thai dinh kJ tai Bgnh vidn Phy s i n Ha NOi trong thang 5/2011 au-ffc thu n h | n vao nghidn cuu n l u t u i i thai > 30 t u i n .
- c a c doi tu'ffng sau khi da a i n g y tham gia nghidn cCru se tra ldi vao p h i l u thu t h l p t h i n g tin ca nhan bao g i m cac thdng tin hanh chinh, t i l n si> bgnh tat ndi chung va t i l n s u s i n khoa, t h i n g tin v l thai nghdn hign tai
- B i i tuffng du'oc lay mau tai Khoa xet nghidm Bgnh vidn Phy San Ha Ndi, m|t i n g mdu ldm xdt nghigm t l bdo. mdt i n g mau iam cdc xdt nghigm ddng mdu.
- c a c ky thugt x i t nghigm difffc thiPC hign theo dung quy trinh hign dang ap dyng tai khoa H u y l t hqc T r u y i n mau Bgnh vign Bach Mai.
2,5. Phdn tich s i lieu. S i ligu duffc phan tich b i n g p h i n m i m Stata 10 0.
3. K^T QUA NGHIEN CIJU
cac k i t qua nghien ciju du'ffc trinh bdy trdn cdc bang 1i-3vahinh 1.
Vietnam Journal of Physiology 17(1), 4/2013 ISSN: 1859-2376
Bang 1. K i t qud xdt nghigm ddng mdu.
Cdc chl s6 xat nghigm ddng mdu SLTC (G/l)
APTTs (s) rAPTT PTs (s) PT%
PT-INR Fibrinogen (g/l)
Nhdm thai phy (n = 60) X±SD 197,33 ±69,5 27,32 ±1,42 0,95 ±0,05 11,25±0.54 105,85 ± 14.88
0,96 ± 0,25 3.90 ± 0.47
Nhdm chirng (n = 20) 'X±SD 252.68 ± 32,07
28.98 ±1.23 1,02 ±0,06 11,62±0.52 101.37 ±735
1,09 ±0,33 2,75 ± 0.38
P
< 0.001
< 0.001
< 0.001
>O05
>005
>ao5
< 0001 K M quS trSn bSng 1 cho th^y cac chi nghTa so vdi nhbm chO'ng tri> PTs, PT%
s6 nghiSn cCru d^u c6 s y b i l n d6i c6 y va INR.
BSng 2. Ket qua cac xSt nghigm ddng mau theo tuoi thai.
Cdc ctii sd xdt nghidm ddng mdu SLTC (G/l) APTTs (s) rAPTT PTs(s) PT%
PT-INR Fibrinogen (g/l)
Thai 30-34 tuin (n = 20) X±SD 247,33 ± 86,76
27,00 ± 0,03 0,94 ± 0,05 11,07 ±0,45 108.02 ±19,30
0,95 ± 0,04 3.55 ± 0.41
Thai 34-38 tudn (n = 20) X±SD 175.45 ±47,77
2723 ±1,26 095 ± 0,04 11,17±0,65 103,93 ± 12,79
0.96 ± 005 4,08 ± 0,32
Thai > 38 tuin (n = 20) J±SD 165,11 ±22,76
27.68 ±1.60 0,96 ± 0,56 11.20 ±0,62 103,03 ±12.51
0,97 ± 0,04 4,12 ± 0,48
P
<0,05
>0,O5
>O05
>0.05
>0,05
>O05
<0,05 cac s6 liSu tren bang 2 cho th^y so luong fibrinogen huylt tuang Igi tang dlin :ilu cku giam dan theo tu5i thai, cdn n6ng dd thai c6;/ nghTa th6ng kS. i6ng dd thai c6') nghTa th6ng kS.
Bang 3. K i t qua xSt nghiSm t l bao mau
theo tu6i
Xdt nghidm td bdo rr-^u SLHC (T/l) Hb (g/l) MCV (11) MCH (pg) MCHC (g/l) SLBC (g/l)
Nhdm thai phy (n = 60) X±SD 4,02 ± 0,50 119.2±1011 90,23 ± 8,40 29.92 ± 3.02 331,43 ±11.41
10,49 ±2,60
Nhdm chu'ng (n = 20) X±SD 4,22 ± 0,56 123.12 ±6.89 89.10 ±7.91 29,12 ±3,54 342,90*11,34
8,76 ± 2,09
P
>0,05
>0,05
>0.05
>0,05
>0.05
>0,05 K i t qua a bang 3 cho thSy chua cd cdng thuc mau giu'a nhdm thai phu vd'i sy khac bi^t cd y nghTa th6ng ke ve nhdm chCrng.
^ r 100%
H L 80% -
^ H 60%
^ B 40%
^ B 20% '
/ ^ ~ ~ ^ M
BThiSumau ^ H• Khong t h i l u mdu
^ 1
Hinh 1. e l thi v l t} Id phy nO' thilu mdu theo tidu chuin cua WHO ff hai n h i m . Theo d l Ihi 1 thly cd d i n 35% s i pho nu'
mang thai ba thdng c u i i trong nghidn ciru ndy du tidu chuin c h i n dodn thilu mdu. trong khi ff nhdm chO'ng con s l nay chi la 10%
4. BAN LUAN
Khi mang thai, s l lu-ffng tieu c l u thudng giam nhg, thu'dng do pha loang hodc do tang dung nap tilu c i u [6). K i t qua cda chiing tdi cung phCi hffp vdi Liu vd cs. [8] vd Boehler va cs [5] Trong nghidn ciru cua chung tdi c6n ghi nhdn duffc sy giam t i l u c l u d thai phu thdng CUOI cung so vdi cac thang trudc i d .
APTTs rOt ngin cQng nhu rAPTT giam so vdi nhdm chu'ng cho thly cd su tdng hoat hda con dudng ddng mdu npi smh K i t qua ndy cung phO hop vdi nghidn ctru cOa cdc tdc gia l<hdc [1], [8] Cdc chi s l nay cho thly khuynh huiing tang ddng d phy nii mang thai d l san sang d i i mat vdi nguy co m i t mdu khi sinh nd [6], Tuy nhign. cac chi s l PTs. PT%, PT-INR mdi t h i hign xu hudng nit ngin, chua cd ^ nghia thing kg so vdi nhdm chiing. vl vdy d l nhgn xdt v l con dudng dong mdu ngoai sinh, cd le cdn phai nghidn cOu thdm.
Ndng dd fibrinogen d phy nO cd thai cao hffh so vdl d phy ny- nhdm chirng cOng phii hop vdl k i t qua cua Nguyin Thi Vdn Anh [IJ Khi phdn nhdm cdc thai phy thdnh ba nhdm theo tuli thai, chiing t l i thly ning dg fibrinogen
huylt tUffng cua nhdm cd tuli thai tCi- trdn 38 t u i n cao hffh so vdi hai nhim cdn lai. K i t qua ndy phil hffp vdi xu hudng tang d i n ning dg fibnnogen huylt tutrng trong thai ky md Cerneca va cs [7] dd ghi nhdn.
Ve cdc chi s i td bdo mdu, khing cd su khdc bigt CO y nghTa thing kg giOa gid tn tmng binh vd dd Igch Chuin d nhdm thai phu so vdi d nhdm chirng Nhung khi d l i chigu vdl tdu chuin chin dodn thllu mdu cua WHO [2] thi v i n cd din 21 thai phy (tmrng duCTig 35%) b| thieu mau. ty Ig nay Id khd cao, mdc du cd mdu cdn nho nhung Chung t l i manh dan khuyen cdo d n cd su quan tdm diing mOt: d i n vigc tlm hilu va kilm sodt v i n a^ thllu mdu ff phg nir mang thai 5, K E T LUAN.
- S i luffng tilu d u trung binh cua nhdm nghidn cdu Id 197.33 ± 69.5 G/1, giam cd y nghia thing kg so vdi nhdm chiing (p < 0,001).
- APTTs tmng binh Id 27,32 ± 1,42 giay, rAPTT Id 0.95 ± 0,05. t h l p hffn nhdm chiing cd y nghia thing kg (p < 0,001).
- PTs la 11,25 ± 0.54 gidy. PT/, la 105,85 ± 14.88%. PT-INR la 0,96 + 0,26, khac bigt khdng cd y nghia thing kd (p > 0.05) so vdi nhdm chOng.
- N i n g dd fibrinogen huyet tUffng Id 3.90 ± 0,47 g/1, tang cd y nghTa t h i n g ke so vdl nhdm chirng (p < 0,001), ff nhdm c i t u i i thai cdng cao thi n i n g d l fibrinogen huyet tuffng
Vietnam Journal of Physiology 17(1), 4/2013 ISSN: 1859-2376
cang cao (p< 0.001).
- Sd lut?ng h6ng c l u la 4,02 ± 0,50 T/l, ning dd Hb la 119,20 ± 10,11 g/l, MCV 90,23 ± 8,40 fl, MCH 29,92 ± 3,02 pg, MCHC 331,43 ± 11,41 g/l, s i lup-ng bgc* c4u la 10,49 ± 2.60 G/l, khdng cd su khac biM so vai nhdm chung.
- S l thai phy thilu mau la 21/60 (35%).
TAi Ll£U THAM K H A O
1. NguySn Thj Vfin Anh (2011) Nghifen ci>u mdt s6 d$c d i l m x6t nghidm mau 6 phg nO mang thang ba thSng 6ku. Lu^n vSn t6t nghidp dgi hpc, Dai hoc Y Ha Ndi.
2. PhOng Xufin Binh (2007) Sinh ly mau.
Trong: Sinh ly hpc, NXB Y hoc. Ha Ndi, tr.
126-133.
3. Doan Th! B6 Hung (2007) Ty l# va nguydn nhan cac r6i lo?n ddng m'au thud'ng gap trong san khoa tai B0nh vi6n HCing Vuong.
Lu§n van thac sy y hpc, Truo'ng Dgi hpc Y Duoc thanh phd Hd Chi Minh.
4. T r i n Thi KhSm, Ngo Van TSi (2008) NghiSn ciJu mdt s6 chi s6 hoa smh va huylt hoc if san phy tien san giSt tgi B§nh vi§n Phy san Trung uong tO 7/2006 d i n 6/2008. Lu$n van tot nghidp bac sJ chuyen khoa c^p II, Dai hgc Y Ha Ndi.
5. Boehlen F, Hohlfeld P, Extermann P, et al. (2000) Platelet count at tenn pregnancy:
a reappraisal of threshold. Obstet Gynecol.
95{1):29-33.
6. Brenner B (2004) Haemostatic changes in pregnancy. Thromb Res. 114(5-6) 409-414.
7. Cerneca F, Ricci G, Simeone R, et al.
(1997) Coagulation and fibrinolysis changes in normal pregnancy, increased levels of procoagulants and reduced levels of inhibitors during pregnancy induce a hypercoagulable state, combined with a reactive fibnnolysis. Eur J Obstet Gynecol Reprod Biol. 73(1):31-36.
8. Liu XH, Jiang YM, Shi H, et al. (2009) Prospective, sequential, longitudinal study of coagulation changes during pregnancy in Chinese women Int J Gynaecol Obstet.
105(3)1240-243.
SUMMARY Hematological characteristics in third
trimester pregnant women Phan Thi Minh N g o c \ LeThi Hieu^
Oo Tien Dung', Nguyen Tuan Tung', Vu Van Truong', Pham Phuong Thao\
Pham Quang Vinh'
^Hanoi Medical Unhrersity
^Hanoi ObsteMcs and Gynecology hospital 'Bach Mai hospital Received Oct.25, 2012; revised Oct. 26, 2012; accepted Nov. 7, 2012 The study aimed at describing some characteristics of blood cells and blood coagulation tests in third trimester pregnant women Subjects: 60 pregnants over 30 weeks of gestation who were managed by Hanoi Obstetrics and Gynecology Hospital (study group) and 20 healthy women In reproducible age (control group). The research parameters were platelet count. PT.
APTT, plasma fibrinogen concentration. RBC, Hb, MCV. MCH. MCHC, WBC by using XTIBOOi Hematotogy-Analyzer and CA1500 fully-automated blood coagulation analyser The results showed that platelet count in the study group was 197.33 ±69 5 G/l. APTTs was 27.32 ± 1.42s, rAPTT was 0.95 ± 0.05.
PTs was 11.25 ± 0.54s, PT% was 105.85 ± 14.88%, PT-INR was 0.96 ± 0.25, and plasma fibrinogen concentration was 3 90 ± 0.47gA.
The longer pregnancy time, the higher plasma fibrinogen concentration. RBC was 4.02 ± 0.50 T/l, Hb concentration was 119.20 ±10.11 g/l. f\/ICV was 90.23 ± 8.40 fl. MCH was 29 92
± 3.02 pg. MCHC was 331.43 ± 11.41 g/l.
WBC was 10.49 ±2 60 GA. Anemia was detected in 35% pregnant women. Thus, excepted PT, the remaining coagulation parameters changed significantly in comparision with the control group while no significant differences attout blood cell tests between two groups The rate of anemia In the pregnant women was 35%.
Key words: blood cells, gestation
