体表心电图P波极性改变对典型心房扑动射频消融结果的评估价值  

Evaluation of the radiofrequency ablation of typical atrial flutter by change in the surface electrocardiogram P-wave polarity

作　　者：汤建民[1] 袁义强 董建增[3] 

机构地区：[1]郑州大学第二附属医院心内科,郑州450003 [2]郑州市第7人民医院医院心内科 [3]北京安贞医院心内科

出　　处：《临床心血管病杂志》2004年第11期690-692,共3页Journal of Clinical Cardiology

摘　　要：目的 :探讨在心房扑动 (AF)射频消融 (RFCA)过程中体表心电图P波极性改变对峡部发生传导阻滞的评估价值。方法 :17例典型AF患者在成功RFCA前后分别行低右房间隔部和侧壁起搏 ,起搏下同步记录体表 12导联心电图 ,分析测量RFCA前后P波电轴、极性和宽度的变化。结果 :RFCA后低右房间隔部起搏 ,体表心电图P波电轴宽度与RFCA前相比差异均无统计学意义 [(- 95± 18)°∶(- 99± 2 1)° ,t=- 1.6 92 ,P >0 .0 5和 (12 7± 33)ms∶(118± 2 4 )ms ,t =- 1.4 2 5 ,P >0 .0 5 ]。RFCA后低右房侧壁起搏 ,体表心电图P波电轴较RFCA前显著右偏 [(14± 32 )°∶(- 6 9± 2 7)° ,t=- 9.16 6 ,P<0 .0 1];14例患者肢体Ⅱ导联P波的极性由RFCA后的负向波变为RFCA前的正向波 ;P波宽度RFCA后和RFCA前相比明显延长 [(173± 33)ms∶(130± 2 6 )ms,t=- 6 .4 70 ,P <0 .0 1]。结论 :三尖瓣环与下腔静脉之间的峡部形成传导阻滞仅使低右房侧壁起搏下体表 12导联心电图发生变化。Objective:Complete conduction block in the myocardial isthmus situated between the inferior vena cava and the tricuspid valve was shown to be a indicator of successful typical atrial flutter ablation(AF). However, its demonstration requires the use of several electrode catheters and increases costs and both procedural and irradiation times. Thus this study is to estimate whether a change in the P-wave polarity on surface electrocardiogram is an indicator of complete isthmus block in the radiofrequency ablation of typical AF. Method:Seventeen patients were studied during low septal and low lateral atrial pacing before and after successful AF ablation. The changes of P-wave axis and polarity within the surface electrocardiogram were analyzed during atrial pacing before and after successful AF ablation.Result:During low septal pacing, there was no significant difference before and after ablation in P-wave axis and width [(-95±18)°∶ (-99±21)°,t=- 1.692,P> 0.05 and (127±33)ms∶ (118±24)ms,t=- 1.425,P> 0.05]. During low lateral atrial pacing, there was a significant P-wave axis rotation towards the right [(14±32)°∶ (-69±27)°,t=- 9.166,P< 0.01, and P-wave polarity in limb Ⅱlead changed from negative to positive in 14 of 16 patients. There was also an increase in P-wave width [(173±33)ms ∶ (130±26)ms,t=- 6.470,P< 0.01].Conclusion: Isthmus block only modifies surface 12-lead electrocardiogram during low lateral atrial pacing. P-wave polarity in limbⅡlead during low lateral pacing could be used as a noninvasive marker of unidirectional counter-clockwise conduction block during AF ablation.

关 键 词：心房扑动 导管消融术 心电描记术 

分 类 号：R541.7[医药卫生—心血管疾病] R540.4[医药卫生—内科学]