隐匿性房室旁道心电图定位特征探讨

回顾分析射频消融成功的３６５例隐匿性房室旁道患者房室折返性心动过速时的逆传Ｐ（Ｐ－）波特点，并比较Ｖ１及食管导联的ＲＰ－（ＲＰ－Ｖ１和ＲＰ－Ｅ）间期，以探讨隐匿性房室旁道的定位特征。结果显示：①Ｉ、ａＶＬ导联（简称Ⅰ－Ｌ导联）显示Ｐ－波倒置的１７５例均为左心旁道，其中左游离壁旁道１５５例、左后隔旁道２０例；Ⅱ、Ⅲ、ａＶＦ导联（简称Ⅱ－Ｆ导联）显示Ｐ－深倒７０例，其中左后隔旁道５０例中有３５例（７０．０％）、右后隔旁道３０例中有２５例（８３．３％）、右游离壁旁道６０例中有１０例（１６．７％），前两者与后者分别相比差异有显著性，Ｐ均＜０．００１。②在左心旁道中，ＲＰ－Ｖ１间期与ＲＰ－Ｅ间期相比（１６６．２±１７．８ｍｓｖｓ１１８．１±１９．２ｍｓ），差异有显著性，Ｐ＜０．０１；在右心旁道中，右前膈、右游离壁旁道ＲＰ－Ｖ１间期与ＲＰ－Ｅ分别相比（１０７．１±１８ｍｓｖｓ１５７．１±１８ｍｓ，１３２．５±１８．６ｍｓｖｓ１８９．２±２３．５ｍｓ），差异有显著性，Ｐ＜０．０１）。Ⅰ－Ｌ导联Ｐ－波倒置为左心旁道的重要表现，Ⅱ－Ｆ导联Ｐ－波深倒是后隔旁道的重要特点，两个导联上Ｐ－波均直立提示右前隔旁道，左心旁道ＲＰ－Ｅ间?

Electrocardiographic Characteristics for Localization of Concealed Accessory Pathway

In order to investigate the localization characteristics of concealed atrioventricular accessory pathways (AP),the characteristics of retrograde P (P-) wave,RP- intervals in lead V1 and esophagus lead in 365 patients with atrioventricular reentrant tachycardia mediated by AP of different location was analyzed in this study.The results showed:①The inversion of P- wave in Ⅰ,aVL Leads was found in 175 cases.Among them,155 cases were left sided free wall AP(LFW),20 cases were left posteroseptal AP(LPS).The deep inversion of P- wave in lead Ⅱ,Ⅲ and aVF was found in 35 of 50(70%) cases with LPS and in 25/30(83.3%) cases with right posteroseptal AP(RPS) and 10/60(16.7%) cases with right free wall AP(RFW)(70% or 83.3% vs 16.7%,P<0.001).②In left side AP,RP-ERP-V1(1571±18 ms vs 107.1±18 ms,189.2±23.5 ms vs 132.5±18.6 ms,respectively,P<0.01).Conclusion:The characteristics of P- and comparison between RP-V1 and RP-E on tachycardia electrocardiogram are valuable to localize the atrioventricular AP.