长RP间期阵发性室上性心动过速的电生理鉴别方法

阵发性室上性心动过速包括房室结折返性心动过速、房室折返性心动过速及房性心动过速等多种类型。目前临床上常用的鉴别方法包括心动过速时应用心室起搏拖带、希氏束不应期/非不应期的心室期前刺激及心房不同部位起搏的方法,窦性心律下应用希氏束旁起搏、心室不同部位/频率刺激等方法。心室起搏拖带可观察多个指标,为临床最常用的鉴别方法之一,但可能造成拖带后"假V-A-A-V"顺序,希氏束不应期的心室期前刺激可能出现假阴性或者导致心动过速终止,不利于鉴别诊断。窦性心律下行希氏束旁起搏和心室不同部位/频率刺激时,结果可能受起搏位置、旁路位置和不应期影响,易造成假阴性结果等。因其各自的优势和局限性,临床上需综合多种鉴别方法以提高诊断准确性,提高手术成功率。

Electrophysiological differentiation of long RP interval Paroxysmal supraventricular tachycardia

Paroxysmal supraventricular tachycardia includes atrioventricular node reentry tachycardia,atrioventricular reentry tachycardia and atrial tachycardia.At present,the commonly used methods in clinical diagnosis include ventricular pacing in tachycardia,pre ventricular stimulation in refractory/non refractory period of his bundle,pacing in different parts of the atrium,parahisian pacing in sinus rhythm and stimulation in different parts of the ventricle.Ventricular pacing is one of the most commonly used methods in clinical diagnosis.However,it may lead to"false V-A-A-V"sequence after pacing.The ventricular pre phase stimulation of his bundle refractory period may appear false negative or lead to termination of tachycardia,which is not condutive to differential diagnosis.The results may be affected by pacing position,bypass position and refractory period when parahisian pacing and ventricular stimulation at different sites/frequencies are performed in sinus rhythm.Because of their respective advantages and limitations,it is necessary to integrate a variety of identification methods to improve the accuracy of diagnosis and the success rate of operation.