长RP’型房室结折返性心动过速的诊断  

DIAGNOSIS OF ATRIOVENTRICULAR NODAL REENTRANT TACHYCARDIA WITH LONG R-P’INTERVAL IN PATIENTS WITH DUAL ATRIOVENTRICULAR NODAL PATHWAYS

作　　者：杨波[1] 唐其柱[1] 陈芳[1] 夏豪[1] 

机构地区：[1]湖北医科大学附属第一医院心内科,430060

出　　处：《交通医学》2000年第3期256-257,共2页Medical Journal of Communications

摘　　要：目的 :探讨长RP’型房室结折返性心动过速 (AVNRT)患者心动过速时食管导联及体表心电图特点 ,并提出避免误诊的要点。方法 :分析 1 1例长RP’型AVNRT患者的食管电生理检查及心内电生理检查资料 ,比较两种检查结果的心电图特点。结果 :食管电生理检查时 ,1 1例患者心动过速时不同程度地存在体表或食管心电图长RP’间期 ,即R -P’ >70ms,且 72 .7%的有P’E 领先于体表P’V1 ,仅 4例确诊为房室结双径路 (DAVNP)伴AVNRT ,余均诊断为隐匿性左侧旁道(CLAP)或DAVNP加CLAP。 6例S2 R跃增≥ 60ms,余 5例S1 R跃增 >60ms。 8例患者V1 导联上有伪r波 ,另 3例患者则在Ⅱ、Ⅲ、aVF导联上有伪s波。所有患者心动过速时均未见到ST段压低≥ 2mm或Ⅱ、Ⅲ、aVF导联T波深倒、双支对称的伪“冠状T波”现象。结论 :食管电生理检查过程中对于诱发长RP’型心动过速者 ,应观察有无S1 R跃增 ,结合体表和食管心电图P’形态特征 ,有助于AVNRT与房室折返性心动过速 (AVRT)的鉴别诊断。Objective:This paper retrospectively analyzed the characteristics of transesophageal and surface ECG in patients with atrioventricular nodal reentrant tachycardia(AVNRT) with long R-P'interval.The key points of avoiding misdiagnosis were investigated.Methods:Data of transesophageal electrophysiology study(TEEPS) and endocardial mapping in 11 patients of AVNRT with long R-P'interval were carefully analyzed and the characteristics of TEEPS and endocardial mapping were compared.Results:During the procedure of TEEPS,11 patients were found to have tachycardia with long R-P' interval,R-P'>70ms.72.7%of them had the phenomenon of P' V1 positioned behind P' E during the tachycardia.Only 4 of 11 cases were diagnosed dual atrioventricular nodal pathways(DAVNP) with AVNRT, the rest were misdiagnosed concealed left sided accessory atrioventricular pathway(CALP) or CLAP plus AVNRT.S 2R jump≥60ms in 6 patients during programmed stimulation,while S 1R jumped>60ms in 5 patients during incremental stimulation. Pseudo r'waves in V 1 could be seen in 8 of 11 patients while pseudo s' waves in Ⅱ、Ⅲ,aVF in the rest 3.None of the patients had depressed ST segment≥2mm or deeply reversed 'pseudo coronary T wave' with symmetrical up and down loop.Conclusions:During the procedure of TEEPS,careful analysis of surface and transesophageal ECGs is helpful in the differentiation of AVNRT with AVRT in patients with tachycardia of long R-P' interval.

关 键 词：食管电生理 房室结双径路 房室旁道 心动过速 诊断 

分 类 号：R541.710.4[医药卫生—心血管疾病]