心电图aVL导联对阵发性室上性心动过速折返途径的鉴别作用  

The Differential Diagnostic Effect of aVL Lead on Electrocardiogram in Patient With Paroxysmal Supraventricular Tachycardia

作　　者：王蒙[1] 陈良华[1] 宋尚明[1] 刘同宝[1] 

机构地区：[1]山东大学附属省立医院心内科,山东省济南市250021

出　　处：《中国循环杂志》2010年第5期356-359,共4页Chinese Circulation Journal

摘　　要：目的:研究体表心电图aVL导联对阵发性室上性心动过速的鉴别诊断作用。方法:选取2009-01至2009-11因症状性阵发性室上性心动过速在我院行心脏射频消融术(RFCA)治疗的连续病例112例,按心动过速类型分为房室结折返性心动过速(AVNRT,n=60)和房室折返性心动过速(AVRT,n=52),比较两者心电图特点。结果:AVNRT与AVRT患者在年龄上差异没有统计学意义(P>0.05),但是AVNRT中女性患者的比例多于AVRT(55.6%和33.3%,P=0.04)。aVL切迹与V1导联伪R波及下壁导联伪S波(标准心电图算法)发生在AVNRT的比例均大于AVRT(P均<0.001)。aVR导联ST段抬高发生在AVNRT的比例小于AVRT(P=0.0001),并且在AVRT患者中71.4%为左侧旁道。QRS电交替在AVRT和AVNRT间差异没有统计学意义(P>0.05)。aVL切迹和V1导联伪R波及下壁导联伪S波诊断AVNRT的敏感性分别为53.3%、46.7%,42.2%,特异性分别是82.1%、84.6%、94.9%。aVL切迹诊断AVNRT的敏感性高于V1导联伪R波及下壁导联伪S波(标准心电图算法),但是三者之间差异没有统计学意义(P>0.05)。结论:aVL切迹多发生于AVNRT并有助于AVNRT和AVRT的鉴别诊断。Objective： To study the differential diagnostic effect of aVL lead on electrocardiogram （ECG） in patients with paroxysmal supraventricular tachycardia. Methods ： A total of 112 consecutive patients with paroxysmal supraventricular tachycardia treated in our hospital from January to November 2009 were evaluated. The patients included 60 of atrioventricular nodal re-entrant tachycardia （ AVNRT group） and 52 of atrioventricular re-entrant tachycardia （AVRT group）. The specific ECG characters were compared between two groups. Results ： There were no statistical difference in patients＇ age, while the female patients were more in AVNRT group than that in AVNT group（55.6% vs. 33.3% ,P =0. 04）. The aVL notch and the standard criteria（pseudo R wave in V1 and pseudo S wave in inferior）were more frequently found in AVNRT group than that in AVRT group（ P 〈 0. 001 respectively）. The ST-seg- ment elevation in aVR lead was less in AVNRT group than that in AVRT group （P = 0.0001 ）, and 71.4% occurred at the left side pathway. The QRS alternant showed no statistical meaning between two groups （ P 〉 0.05 ）. The diagnostic sensitivity for AVNRT by aVL notch,pseudo R wave and pseudo S wave were 53.3% ,46. 7% ,d2.2% respectively,and the diagnostic specificity were 82. 1%, 84. 6%, 94. 9% respectively. The diagnostic sensitivity for AVNRT by aVL notch was higher than that of pseudo R wave and pseudo S wave according to the standard ECG calculation method. Conclusion： The aVL notch was more frequently occurred in AVNRT, it was helpful in differential diagnosis between AVNRT and AVRT.

关 键 词：aVL切迹 房室结折返性心动过速 房室折返性心动过速 

分 类 号：R541.7[医药卫生—心血管疾病]