双极食管心电图对P波的形态特征及右侧隐匿性旁道的诊断

目的探讨双极食管心电图P波的形态特征以及其对右侧隐匿性旁道的诊断价值。方法选择经心内电生理检查和射频消融术证实的32例右侧隐匿性旁道患者。消融术前经食管心房调搏诱发阵发性室上性心动过速发作,以相同的走纸速度和振幅记录发作前后体表12导联、单极食管、双极食管心电图。分别观察P波形态、极性、P波与QRS波关系,测量P波振幅、时限,以心内电生理检查结果为标准分析单极与双极心电图对右侧隐匿性旁道的诊断灵敏度。结果单极食管心电图P波无极性变化,双极食管心电图P波可根据需要调整极性。双极食管心电图和单极食管心电图的P波振幅分别为0.55±0.10mV和0.34±0.10mV(P<0.05),P波时限分别为98.4±11.2ms和101.2±12.5ms(P>0.05)。单极食管心电图和双极食管心电图对右侧隐匿性旁道的诊断灵敏度分别为68.8%和93.8%(P<0.05)。结论双极食管心电图记录的P波振幅大于单极食管心电图,并能更清晰的显示P波以及P波与QRS波之间的关系,对右侧隐匿性旁道的诊断优于单极食管心电图。

The diagnosis of bipolar esophageal electrocardiogram on features of P wave and right dormant atrioventricular accessory pathway

Objective To discuss the diagnostic value of bipolar esophageal electrocardiogram on features of P wave and right dormant atrioventricular accessory pathway. Methods The 12 leads superficial ECG, unipolar and bipolar esophageal ECG were recorded in 32 patients with right dormant atrioventricular accessory pathway diagnosed by radiofrequency ablation and the whole process of transoesophageal electrophysiological exammination. The shape and polarity of P wave and the relationship between P wave and QRS complex were observed in each ECG. The duration and voltage of P wave were measured and the diagnostic sensitivity of the right dormant atrioventricular accessory pathway was compared between the unipolar and bipolar esophageal ECG. Results There was no polar change of P wave in unipolar esophageal ECG while the polarity of P wave could be adjusted according to the need in the bipolar esophageal ECG. The voltage of P wave was significantly higher in bipolar esophageal ECG than that in unipolar esophageal ECG(0.55±0.10 mV vs 0.34±0.10 mV,P<0.05). With the results obtained from electrophysiological studies as the standard, the diagnostic sensitivity of right dormant atrioventricular accessory pathway of unipolar and bipolar esophageal ECG were 68.8% and 93.8% respectively(P<0.05). Conclusion The bipolar esophageal ECG is exacter on the diagnosis on right dormant atrioventricular accessory pathway than that of unipolar esophageal ECG, because the former can record the P wave with higher voltage and display the P wave esophagealmore clearly.