不同胸静脉起搏时体表心电图P波特点  

The ECG morphological characteristics of P-wave during selective veins within the chest pacing

作　　者：张棠[1] 刘浩[1] 李希[1] 伍伟锋[1] 朱立光[1] 曾晓春[1] 杨仁贵[1] 唐瑞庆[1] 

机构地区：[1]广西医科大学第一附属医院心内科,广西南宁530021

出　　处：《中国心脏起搏与心电生理杂志》2012年第5期418-421,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：广西医疗卫生重点科研课题(项目编号:重200411)

摘　　要：目的分析胸静脉起源的房性心律失常12导联体表心电图P波形态特点,为心律失常定位提供帮助。方法 35例药物治疗无效的阵发性心房颤动患者行射频消融前,将消融电极分别送至上肺静脉顶部,下肺静脉底部,上腔静脉靠间隔侧起搏。记录起搏前窦性心律(SR)下以及各部位起搏后体表12导联心电图P波图形,分析P波的振幅、时限、极性等形态特点。结果 P波时限左肺静脉比右肺静脉长。同侧上、下肺静脉P波时限无差异。下壁导联和胸导联上腔静脉比SR的P波时限长。P波振幅,SR下和各个胸静脉胸导联上无差异。下壁导联上同侧肺静脉比下肺静脉高,左、右肺静脉之间的P波振幅无差异,而上腔静脉比SR的P波振幅高。肺静脉的P波极性在胸导联都为正向波,而SR和SVC的P波极性在V1、V2导联可呈正向、负向及正负双向,其余胸导联为正向。结论不同胸静脉起源的心电图P波具有不同形态特点,可为临床胸静脉起源的房性心律失常定位提供帮助。Objective To analyze the atrial arrhythmias of thoracic vein origin with a 12 lead ECG and the associated P-wave morphological charactyeristics,to help in localizing the position of arrhythmias. Methods A total of 35 paroxysmal atrial fibrillation（PAF） patients who were refractory or intolerant of antiarrhythmic drugs were selected. A quadripolar ablation catheter was advanced to veins within the chest, and then pacing inside veins within the chest was performed before radiofrequency ablation of PAF. The P-wave amplitude, duration and morphology were assessed and analyzed. Results P wave duration of left pulmonary vein （PV） was more longer than that of right PV, but that of superior and inferior PV at the ipsilateral side had no statistical difference. P wave duration of inferior wall leads and chest leads in superior PV was longer than that of sinus P wave. In chest leads, there was no significant difference in P wave amplitude of sinus rhythm and that of PV. Inferior leads showed higher P wave amplitude in superior PV than ipsilateral inferior pulmonary vein but there was no difference between that of right and left PV. P wave amplitude in superior PV was higher than that of sinus rhythm. In chest leads, the polarity of P wave in PV were all positive ; though that of P wave in sinus rhythm and superior vena eava showed positive, negative and biphasic deflation in Vl and V2, and showed positive in other chest leads. Con- clusions Characteristic P-wave morphology is corresponded to identify the sites of origin for focal atrial tachycardia origina- ting from veins within the chest with high specificity and sensitivity.

关 键 词：心血管病学 房性心律失常 胸静脉起源 P波 定位诊断 

分 类 号：R541.7[医药卫生—心血管疾病] R540.41[医药卫生—内科学]