室上性心动过速时V_1导联rSr’波的诊断价值

目的　分析经射频消融术证实的 146例房室结双径路合并慢快型折返性心动过速和 12 0例隐匿性预激综合征病人的窦性心律和房室结折返性心动过速时的体表心电图 ,总结具有特异性改变的图形 ,提高体表心电图鉴别室上性心动过速的发生机制以及诊断房室结双径路的准确率。方法　用对比的方法分析窦律下和心动过速时 12导联体表心电图 ,找出心动过速时逆传P’波在不同导联的位置及与QRS波的关系。结果　房室结双径路的病人心动过速时 ,体表心电图 12导联均无逆传P’波 30例 ,发生率 2 0 5 % ;肢体导联无逆传P’波 ,而V1导联呈rSr’波 84例 ,发生率 5 7 5 % ;肢导有假s波 ,V1导联呈rSr’波 2 9例 ,发生率 19 9% ;12导联有假 q波 3例 ,发生率 2 1%。隐匿性预激的病人V1导联仅 1例出现rSr’图形。结论　体表心电图V1导联的rSr’波对房室结双径路合并室上速的诊断特异性强 ,准确性高 ,是快速、准确诊断房室结折返性心动过速的极为有价值的方法。

The diagnostic value of rSr' complex in V_1 lead during supraventricular tachycardia

Objective We analyzed the surface ECG of 146 patients with dual atrioventricular nodal pathway and that of 120 patients with concealed W-P-W syndrome, which were confirmed by RFCA during sinus rhythm and tachycardia, and summarized the distinguishing features of ECG to increase the diagnostic accuracy of atrioventricular nodal reentrant tachycardia.Methods We compared the surface ECG in 12 leads during sinus rhythm with tachycardia, and tried to find the relation between the different locations of retrograde P' wave and QRS complex in all leads.Results There was no retrograde P' wave in 30 patients ECG, the occurrence rate was 20 5%. There were 84 patients without retrograde P' wave in limb leads but with rSr' complex in V 1 lead, occurrence rate 57 5%; 29 patients with pseudo-s wave and rSr' complex in V 1 lead, occurrence rate 19 9%; 3 patients with pseudo-q wave, 2 1%. Only one patient with concealed W-P-W syndrome appeared rSr' complex in V 1 lead.Conclusion The specialty and accuracy of rSr' complex in V 1 lead is higher for the diagnosis of dual atrioventricular nodal pathway with supraventricular tachycardia. It is a very useful method in diagnosing dual atrioventricular nodal reentrant tachycardia rapidly and accurately in the surface ECG.