aVL导联切迹对慢快型房室结折返性心动过速的诊断价值  

Value of Lead aVL Notch on Slowfast Atrioventricular Node Reentrant Tachycardia

作　　者：欧阳清彦[1] 邹月娥[1] 涂爱兰[1] 

机构地区：[1]广东省佛山市第二人民医院

出　　处：《中西医结合心脑血管病杂志》2011年第3期295-296,共2页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

摘　　要：目的探讨aVL导联切迹在慢快型房室结折返性心动过速(AVNRT)和顺传型房室折返性心动过速(AVRT)鉴别诊断中的作用。方法对138例经心内电生理检查及射频导管消融术治疗成功的阵发性窄QRS波心动过速患者12导联心电图进行分析,其中AVNRT 74例,AVRT 64例,比较传统指标与单独aVL导联切迹对AVNRT与AVRT鉴别价值。结果 aVL导联切迹在AVNRT出现29例(39.2%),在AVRT出现1例(P<0.01);下壁导联伪s波在AVNRT出现28例(37.8%),在AVRT出现1例(1.6%,P<0.01);V1导联伪r'波在AVNRT出现33例(44.6%),在AVRT出现3例(4.7%,P<0.01)。aVL导联切迹诊断AVNRT的敏感性为39.2%、特异性为98.4%;下壁导联伪s波诊断AVNRT的敏感性为37.8%、特异性为98.4%;V1导联伪r'波诊断AVNRT的敏感性为44.6%、特异性为95.3%,三种判断标准的敏感性、特异性差异无统计学意义(P>0.05)。结论以aVL导联切迹为判断标准,对慢快型AVNRT的诊断特异性强,敏感性较高,可作为房室结折返性心动过速的诊断指标之一。Objective To evaluate the diagnostic value of aVL lead on differential diagnosis of slow-fast atrioventricular node re-entrant tachycardia（AVNRT） from atrioventricular reciprocating tachycardia（AVRT）.Methods One hundred and thirty-eight patients（pts） with paroxysmal narrow QRS complex tachycardia were included.Electrophysiologic study and radiofrequency catheter ablation were performed.There were 74 episodes of atrioventricular node re-entrant tachycardia（AVNRT）,and 64 episodes of atrioventricular reciprocating tachycardia（AVRT）.The standard criteria（pseudo-S-wave in the inferior leads and pseudo-r＇ in V1 lead） were compared with the value of isolated aVL lead in pts with AVNRT and AVRT.Results The aVL notch was found during AVNRT in 29 episodes（39.2%） vs.1 episodes（1.6%） in AVRT（P0.01）.The pseudo-S-wave in the inferior leads was found during AVNRT in 28 episodes（37.8%） vs.1 episode（1.6%） in AVRT（P0.01）.The pseudo-r＇ in V1 lead was found during AVNRT in 33 episodes（44.6%） vs.3 episodes（4.7%） in AVRT（P0.01）.The aVL notch sensitivity to diagnose AVNRT was 39.2%,and its specificity was 98.4%.Pseudo-S-wave sensitivity in the inferior leads to diagnose AVNRT was 37.8%,and its specificity was 98.4%.Pseudo-r＇ sensitivity in V1 lead to diagnose AVNRT was 44.6%,and its specificity was 95.3%.There was no significant difference in sensitivity and specificity（P0.05）.Conclusion The aVL lead notch had very high specificity and higher sensitivity for diagnosis of slow-fast atrioventricular node re-entrant tachycardia.

关 键 词：aVL导联切迹 慢快型房室结折返性心动过速 顺传型房室折返性心动过速 

分 类 号：R541.7[医药卫生—心血管疾病] R256.2[医药卫生—内科学]