体表与食管心电图在隐匿性房室旁路诊断及定位中的价值

目的探讨诊断隐匿性房室旁路的简易方法。方法110例经心内电生理确诊并成功消融的隐匿性房室旁路患者。术前行食管心房调搏检查,观察S2R2有无跳跃性延长;记录心动过速时的体表心电图,观察逆传P波的方向及形态;同步记录食管与V1导联心电图,观察P波在V1(P-V1)及食管导联(P-E)的先后顺序。结果110例中106例S2R2呈逐渐延长。67例左侧旁路房室折返性心动过速时P-E先于P-V1,39例右侧旁路P-V1先于P-E,4例中间隔旁路P-E与P-V1几乎同时出现。且不同部位的房室旁路在不同导联上逆传P波形态不同,并有显著差别。结论隐匿性房室旁路可根据心动过速时的体表心电图P波的方向及形态作出初步诊断,结合食管与V1导联同步心电图以及食管调搏结果可基本确定诊断。

Evaluation of the role of surface and esophagus electrocardiogram in diagnosing and localization of concealed atrioventricular pathway

Objective To evaluat the role of surface electrocardiogram, esophagus and V1 synchronization electrocardiogram and esophageal pulsation modulation in diagnosing and localizing of concealed atrioventricular pathway. Method 110 patients with concealed atrioventricular pathway underwent electrophysiology examination and radiofrequency ablation successfully. S2R2 was observed during esophageal pulsation modulation. Retrograde P wave polarity was determined by surface ECG recorded during atrioventricular reentrant tachycardia. Sequence of retrograde P wave in V1 (P- V1) and esophageal lead(PE-) was observed by esophagus and V1 synchronization electrocardiogram. Result S2R2 prolonged progressively in 106 patients. PE- was prior to PV1- in 67 patients with left accessory pathway while PV1- was prior to PE- in 39 patients with right accessory pathway during tachycardia. PV1- and PE- occurenced simultaneously in 4 patients with midseptal accessory pathway. Retrograde P wave polarity has significant differential among patients with varied localization of concealed atrioventricular pathway by surface ECG recorded during atrioventricular reentrant tachycardia. Conclusion Concealed atrioventricular pathway can be determined by overview of P wave in surface electrocardiogram, esophagus and V1 synchronization electrocardiogram and esophageal pulsation modulation.