体表心电图对阵发性窄QRS波心动过速鉴别诊断及定位的价值

目的:通过分析152例阵发性窄QRS波心动过速（NQRST）患者体表心电图（ECG）的6种指标,探讨ECG对NQRST鉴别诊断及定位的价值。方法:选取152例NQRST患者,其中94例为房室结折返性心动过速(AVNRT),42例为房室折返性心动过速（AVRT),16例为房性心动过速(AT)。上述患者电生理机制均经腔内电生理检查所证实,对比分析每位患者窦性心律及心动过速发作时体表心电图在心率、ST-T改变、QRS波电交替、R-P′/P′-R相似文献   

心电图aVL导联对阵发性室上性心动过速折返途径的鉴别作用

目的:研究体表心电图aVL导联对阵发性室上性心动过速的鉴别诊断作用。方法:选取2009-01至2009-11因症状性阵发性室上性心动过速在我院行心脏射频消融术(RFCA)治疗的连续病例112例,按心动过速类型分为房室结折返性心动过速(AVNRT,n=60)和房室折返性心动过速(AVRT,n=52),比较两者心电图特点。结果:AVNRT与AVRT患者在年龄上差异没有统计学意义(P0.05),但是AVNRT中女性患者的比例多于AVRT(55.6%和33.3%,P=0.04)。aVL切迹与V1导联伪R波及下壁导联伪S波(标准心电图算法)发生在AVNRT的比例均大于AVRT(P均0.001)。aVR导联ST段抬高发生在AVNRT的比例小于AVRT(P=0.0001),并且在AVRT患者中71.4%为左侧旁道。QRS电交替在AVRT和AVNRT间差异没有统计学意义(P0.05)。aVL切迹和V1导联伪R波及下壁导联伪S波诊断AVNRT的敏感性分别为53.3%、46.7%,42.2%,特异性分别是82.1%、84.6%、94.9%。aVL切迹诊断AVNRT的敏感性高于V1导联伪R波及下壁导联伪S波(标准心电图算法),但是三者之间差异没有统计学意义(P0.05)。结论:aVL切迹多发生于AVNRT并有助于AVNRT和AVRT的鉴别诊断。     

体表心电图特征对典型的房室结折返性心动过速和房室折返性心动过速的鉴别作用

对150例射频消融明确诊断的窄QRS心动过速患者的窦性心律和发作室上性心动过速时的心电图进行分析,从而归纳出典型的房室结折返性心动过速(AVNRT)和房室折返性心动过速(AVRT)心电图特征的差异.结果 5项心电图指标对区分这两种心动过速类型有意义.认为对于AVNRT有预测作用的为伪r′波(V1导联)和伪S波(Ⅱ、Ⅲ、aVF导联).对于AVRT有预测作用的为逆传P波,RP′间期≥70 ms及ST段改变.     

频率不规则的阵发性室上性心动过速

阵发性室上性心动过速的狭义概念是指依赖房室结做为折返环路的室上性心动过速,包括房室结折返性心动过速(AVNRT)和房室折返性心动过速(AVRT)。AVNRT和AVRT一般表现为心房率、心室率规则的心动过速,但在折返环某个部位的传导速度、不应期发生改变或受折返环以外的因素干扰、心动过速发作和(或)终止时也可导致心房率、心室率的不规则,比较常见的有①AVNRT伴房室2∶1传导阻滞或文氏传导阻滞;②AVNRT、AVRT伴RR间期长短交替;③AVRT伴房性早搏或室性早搏;④AVNRT伴心房颤动。     

体表心电图对房室结折返性与房室折返性心动过速的鉴别诊断

为探讨体表心电图对房室结折返性和房室折返性心动过速的鉴别诊断价值,对以射频导管消融、心脏电生理检查、心外膜标测的方法确诊房室结折返性心动过速(AVNRT)和房室折返性心动过速(AVRT)的88例患者的室上性心动过速发作时心电图作对照研究。结果显示:(1)P'波出现率在AVNRT占33％,在AVRT占100％(P<0.01)。(2)R-P'间期<80ms时常见于AVNRT,而≥80ms多见于AVRT(P<0.01)。(3)AVNRT在下壁导联(Ⅱ、Ⅲ、aVF)常见假性S波,而V_1导联常合并假性r波。(4)AVRT无文氏现象,但常出现束支传导阻滞改变且符合Coumel-Slama定律。认为以上特点对两者鉴别诊断有重要价值。     

体表心电图对AVRT及AVNRT的诊断价值和方法

通过对６６例房室折返性心动过速及房室结折返性心动过速及体表心电图与心内电生理检查结果对比分析,总心动过速时体表心电图逆传Ｐ波使波形改变的规律,从而利于用体表心电图对ＡＶＮＲＴ及ＡＶＲＴ鉴别诊断。     

易漏诊阵发性室上性心动过速1例

1 病历摘要 患者,女,60岁,因胸闷、心悸半小时来诊.半小时前劳累后出现胸闷、心悸,经休息不缓解,急来我院.病程中无心前区疼痛,无呼吸困难,无咳嗽及咳痰,饮食及二便正常.既往史:2年前有过类似症状发作,在当地医院就诊,但未明确诊断.否认肝炎、结核等传染病史.否认冠心病、糖尿病、高血压病史.否认药物过敏史.查体:体温36.5℃,脉搏130次/min,血压120/80 mmHg.意识清楚,查体合作.皮肤干燥.双侧瞳孔等大同圆,直径5 mm.巩膜无黄染,结膜无苍白.     

异搏定治疗阵发性室上性心动过速的疗效分析

室上性心动过速(室上速)是临床上常见的心律失常。按折返环形成的部位分为4类:房室结折返性心动过速,房室折返性心动过速,窦房折返性心动过速,房内折返性心动过速。笔者应用异搏定治疗室上速15例,现对疗效分析如下:1　资料及方法1.1　一般资料1990～1998年我科住院室上速病人共15例次,男性8例,女性7例,年龄18～65岁,住院3～15日。诊断均符合“临床疾病诊断依据及心电图诊断标准”[1]。病因诊断:冠心病2例,慢性肺心病2例,心肌炎2例,可疑预激综合征1例,正常人或不明原因8例。其中2例病人发作时出现低血压,1例出现晕厥。1.2　方法除了病因治疗…     

射频消融治疗阵发性室上性心动过速110例

目的分析射频消融(RFCA)治疗阵发性室上性心动过速(PSVT)的疗效。方法回顾性分析110例患者临床资料,均采用常规RFCA治疗PSVT患者。结果房室折返性心动过速(AVRT)65例,预激综合征合并房颤3例,计有旁道70条,显性旁道35条,隐匿性旁道35条,其中位于冠状静脉窦憩室颈部心外膜旁道1例,双旁路2例均为左侧。房室结折返性心动过速(AVNRT)42例,均为慢-快型,其中有两例患者术中未能诱发出心动过速,予RFCA阻断慢径治疗。RFCA治疗PSVT总成功率为99.1%,其中房室结双经路介导的PSVT成功率高达100%,复发率为3.6%,均复治成功,并发症发生率5.6%。结论采用常规方法RFCA治疗PSVT成功率高,并发症少。     

心室起搏拖带对房室结折返性和间隔旁路参与的房室折返性心动过速的鉴别作用

目的　研究心动过速时心室起搏拖带对房室结折返性心动过速 (AVNRT )和间隔旁路参与的顺向型房室折返性心动过速 (间隔旁路ORT)的鉴别意义。方法　 30例AVNRT和 2 5例间隔旁路ORT病人在心动过速发生后 ,采用较心动过速的周长 (TCL)短 10～ 4 0ms的周长行右心室起搏拖带心动过速。测量右心室起搏之前的心室 心房 (VA)间期和TCL。停止起搏后 ,测量最后一次刺激信号至最后起搏拖带的心房激动 (SA)间期 ,以及起搏后间期 (PPI)。结果　所有 30例AVNRT病人的SA -VA间期 >85ms、PPI-TCL >115ms,而 2 5例ORT病人的SA -VA间期 <85ms、PPI-TCL <115ms。结论　PPI TCL和SA VA间期是鉴别AVNRT和间隔旁路ORT的非常可靠的指标 ,具有较高的特异性。     

常规心电图对典型的房室结折返性心动过速和顺传型房室折返性心动过速的鉴别作用

目的探讨12导联心电图对阵发性窄QRS心动过速中最常见两种类型--典型的房室结折返性心动过速（AVNRT）和顺传型房室折返性心动过速（AVRT）的鉴别作用.方法对206例阵发性窄QRS心动过速（QRS〈0.11 s,心室率〉120次/min）患者的心电图进行了分析.第一部分分析139例患者的心电图,从中归纳出1个12导联心电图算法（algorithm）.第二部分前瞻性分析了67例患者的心电图,以检测这一算法的准确性.心动过速的机制和旁路位置均由成功的射频导管消融术确定.结果 5项心电图指标对区分这两种心动过速类型有意义.对于AVNRT有预测作用的为伪r′波（V1导联,敏感性53%、特异性96%）,伪S波（Ⅱ、Ⅲ、aVF导联,敏感性21%、特异性100%）.对于AVRT有预测作用的为逆传P波（敏感性89%、特异性68%）,RP间期〉70 ms（敏感性90%、特异性91%）,及ST段改变.ST段改变归纳出3个联合指标,分别为：V4、V5导联ST段同时下降≥2 mm（敏感性24%、特异性94%）;V5、V6导联ST段同时下降≥1 mm（敏感性41%、特异性81%）;V6导联ST段同时下降≥1 mm和aVR导联ST段抬高≥1 mm同时出现（敏感性30%、特异性85%）.V1导联逆传P波极性对于旁路的初步定位有帮助,左侧旁路大多为直立、双向或平坦的逆传P波,右侧旁路大多为倒置的逆传P波.12导联心电图算法对心动过速机制的正确诊断率分别为85%和82%.对于AVRT旁路位置的正确判断率为75%～86%.在3个联合指标中,V5、V6导联ST段同时下降≥1 mm的鉴别作用最佳.结论心电图算法有助于更加准确地鉴别阵发性窄QRS心动过速的机制,并且可以对旁路初步定位.     

Electrocardiographic differentiation of typical atrioventricular node reentrant tachycardia from atrioventricular reciprocating tachycardia mediated by concealed accessory pathway in children

The value of the electrocardiogram (ECG) in children with supraventricular tachycardia (SVT) is unclear. The noninvasive differentiation of typical atrioventricular node reentrant tachycardia (AVNRT) and atrioventricular reciprocating tachycardia (AVRT) mediated by concealed accessory pathway conduction is clinically important, as it helps in counseling and potentially facilitates ablation procedures. One hundred forty-eight ECGs showing narrow QRS complex SVT were obtained from children before successful radiofrequency catheter ablation. An initial 102 ECGs were analyzed by 3 blinded observers to assess the utility of various electrocardiographic findings. No electrocardiographic criteria were found to discriminate between SVT mechanisms on 1- to 3-channel Holter/event recorder tracings (n = 32); their interpretation mainly (55%) resulted in an incorrect SVT diagnosis. On 12-lead ECGs (n = 70), the 2 arrhythmias were accurately diagnosed in 76% of patients; 5 findings were found to be discriminators of tachycardia mechanism. Predictors of AVRT were visible P waves in 74% of cases (sensitivity 92%; specificity 64%), RP intervals of > or =100 ms in 91% (sensitivity 84%; specificity 91%), and ST-segment depression of > or =2 mm in 73% of cases (sensitivity 52%; specificity 82%). Pseudo r' waves in lead V(1) and pseudo S waves in the inferior leads during tachycardia predicted AVNRT in 100% of cases (sensitivity 55% and 20%, respectively; specificity 100% for both). Based on these results, we developed a new diagnostic 12-lead electrocardiographic algorithm for pseudo r'/S waves, RP duration, and ST-segment depression during tachycardia. Two observers tested the algorithm in 46 (21 AVNRT; 25 AVRT) additional cases; they correctly diagnosed the SVT mechanism in 91% and 87%, respectively. Thus, the stepwise use of diagnostically relevant 12-lead electrocardiographic parameters helps to more accurately differentiate mechanisms of reentrant SVT.     

A new algorithm for concealed accessory pathway localization using T-wave-subtracted retrograde P-wave polarity during orthodromic atrioventricular reentrant tachycardia

INTRODUCTION: AP localization can be predicted by analyzing the polarity of the delta wave, QRS polarity, and R/S ratio in patients with Wolff-Parkinson-White syndrome. However, the estimation of AP location is limited in patients with concealed pathways during atrioventricular reentrant tachycardias (AVRT). Thus, we analyzed retrograde P-wave polarity during orthodromic AVRT and developed an algorithm to predict the localization of concealed accessory pathways (AP). METHODS AND RESULTS: A total number of 131 patients with a single AP and inducible orthodromic AVRT were included. The initial 61 patients were analyzed retrospectively for algorithm development, whereas 70 patients were evaluated prospectively. The retrograde P-wave polarity was analyzed by subtracting the superimposing T-wave during orthodromic AVRT using custom-designed software. Four leads of the surface electrocardiogram (ECG) were identified to accurately distinguish AP locations assigned to four different regions around each AV annulus: I, aVR, aVL, and V(1). Lead V(1) was used to differentiate right (negative or isoelectric) from left (solely positive) APs. Retrograde P-wave in lead I was negative in left posterior APs exclusively and became more positive with an AP location shifting towards right anterior. P-wave polarity in lead aVR demonstrated a shift from a positive polarity from left APs to isoelectric in right APs. The opposite direction (shift from positive to isoelectric) was observed for lead aVL. The subsequently developed algorithm for concealed AP localization using these surface ECG leads demonstrated a high sensitivity, specificity, and positive predictive value particularly for common AP localizations (left posterior and inferior, and right septal) when applied in a prospective fashion. CONCLUSION: Concealed AP localization can be accurately predicted by the analysis of retrograde P-wave polarity during orthodromic AVRT using the algorithm derived from the presented study.     

房室折返和房室结折返性心动过速患者的个性分析

目的探讨房室折返性心动过速(AVRT)和房室结折返性心动过速(AVNRT)患者的个性特征。方法采用龚耀先修订的艾森克个性问卷量表,对83例AVRT、105例AVNRT患者射频消融前后和50例对照组正常人的精神质(P)、内外向(E)、情绪稳定性(N)和掩饰倾向(L)值进行测量。结果射频消融前后,各组之间的P、E、N和L值相比较差异无显著性(P>0.05);射频消融前后AVNRT组内女性患者的N分值较男性高(分别为12.93±2.83vs9.88±2.61;12.84±2.87vs9.87±2.64;P均<0.05)。结论AVNRT女性患者具有神经质倾向,这可能是在AVNRT中女性占多数的原因之一。     

Atrial tachycardia with slow pathway conduction mimicking typical atrioventricular nodal reentrant tachycardia.

A 68-year-old woman with palpitations underwent electrophysiologic testing. During burst atrial pacing the PR interval exceeded the RR interval and induced a supraventricular tachycardia consistent with a typical AV nodal reentrant tachycardia (AVNRT). Radiofrequency ablation of the slow pathway during the tachycardia immediately produced 2 : 1 AV conduction. After slow AV nodal pathway ablation an atrial tachycardia (AT) remained inducible with the earliest atrial activation around the HB region. Radiofrequency ablation at the site of earliest atrial activation interrupted the AT without AV block. AT originating from the HB region with slow pathway conduction may mimic typical AVNRT.     

心房不同部位拖带法鉴别不典型房室结折返性心动过速和房性心动过速

目的报道一种鉴别不典型房室结折返性心动过速(AVNRT)和起源点邻近Kock三角的房性心动过速(AT)的新方法。方法 22例室上性心动过速患者,在心房不同部位(右房心耳部、冠状静脉窦近端、远端)起搏拖带心动过速,测定起搏后VA间期(最后一个起搏脉冲前传夺获的心室电图到起搏终止后第一心搏的最早心房电图的距离)。计算各部位起搏后VA间期的差别并取差别绝对数的最大值定义为ΔVA间期。结果 13例AVNRT起搏后ΔVA间期5.8±3.6(0～14)ms,9例AT起搏后ΔVA间期62.8±24.2(21～98)ms。ΔVA间期在所有AVNRT均<15 ms,在所有AT均>15 ms,因此起搏后ΔVA间期>15 ms用于诊断AT的灵敏度和特异度均为100%。结论心房不同部位起搏拖带法可用于准确鉴别不典型AVNRT和起源点邻近Kock三角的AT。     

房室折返性心动过速的重整现象

目的:探讨房室折返性心动过速(AVRT)的重整特点及对经典重整概念的质疑。方法:选择41例行射频消融治疗的顺向型AVRT患者,心动过速发作时,在心脏的不同部位进行S2刺激扫描,观察心动过速对S2刺激的重整反应。结果:28例(其中左侧房室旁路19/32例,右侧房室旁路9/9例)经高位右房AS2刺激可以使心动过速重整,39例(其中左侧房室旁路30/32例,右侧房室旁路9/9例)经右心室VS2刺激可以使心动过速重整。其中8例左侧旁路患者从左心房、左心室刺激均能发生重整。重整时,偶联间期与回归周期之和(即代偿间歇)与心动过速周长(CL)的关系有3种不同的表现。结论:重整与刺激部位到折返环的距离密切相关;代偿间歇不仅可以小于CL的2倍,也可以大于或等于CL的2倍。