心室起搏对后间隔旁道与快径逆传的诊断价值

通过右室心尖部和基底部两个不同部位的起搏，比较１５例房室结折返性心动过速（对照组）和８例隐匿性后间隔旁道参与的房室折返性心动过速患者（观察组）的室房传导时间（ＶＡＩ）。结果显示：①心尖部起搏时对照组ＶＡＩ为１７４±３４ｍｓ，与观察组１８６±３８ｍｓ相比无显著性差异（Ｐ＝ＮＳ）。②基底部起搏时观察组ＶＡＩ为１５３±２４ｍｓ，明显短于对照组１９９±３４ｍｓ，两者比较有显著性差异（Ｐ＜０．０１）。③两个部位（心尖部与基底部）ＶＡＩ的差值对照组≤０（－５０～０，平均－２４±１６ｍｓ）与观察组≥１５ｍｓ（１５～７５，平均３４±１９ｍｓ）比较有非常显著性差异（Ｐ＜０．００１）。提示右室心尖部与基底部连续起搏可快速、准确地鉴别室房传导是经快径路还是后间隔旁道

Diagnostic Value of Ventricular Pacing on Establish Whether the Retrograde Conduction is Proceeding Over A Posteroseptal Accessory Pathway or A Fast Pathway

Using decremental pacing from apical and posterobasal right ventricular sites,the ventriculoatrial interval (VAI) was compared between 15 patients with atrioventricular nodal reentrant tachycardia (group 1) and 8 patients with atrioventricular reentrant tachycardia mediated by a concealed posteroseptal accessory pathway (group 2).Results:During apical pacing,VAI in group 1(174±34 ms) was not significantly different from VAI in group 2 (186±38 ms, P =NS).During posterobasal pacing,group 2 patients had significantly shorter VAI than group 1 patients(153±24 ms vs 199±34 ms, P <0.01).The differences of VAI during apical pacing and during posterobasal pacing could discriminate between the two groups without overlapping.It was postive in all group 2 patients(34±19 ms;range 15 to 75 ms) and negative in group 1 except two patients(-24±16 ms;range -50 to 0 ms, P < 0.001 ).Conclusion:Right ventricular pacing from apical and posterobasal sites can identify rapidly and accurately whether the retrograde conduction is proceeding over a posteroseptal accessory pathway or a fast pathway.