单支房室旁路心电图定位的规则系统  

Surface Electrocardiogram Criteria for the Localization of Single Atrioventricular Accessory Pathway

作　　者：任在镐[1] 胡大一[2] 吴旸[2] 吴永金 商丽华[2] 余培桢[3] 许春萱[4] 王建安[5] 徐耕[1] 黄从新[6] 郭继鸿[7] 张树龙[8] 

机构地区：[1]浙江大学医学院附属第二医院心内科,310009 [2]首都医科大学附属北京同仁医院心脏中心 [3]中国医学科学院阜外心血管病医院电生理研究室 [4]福建省立医院心内科 [5]浙江大学附属邵逸夫医院心内科 [6]湖北医科大学附属第一医院心内科 [7]北京大学人民医院心内科 [8]大连医科大学附属第一医院心内科

出　　处：《中国医药导刊》2001年第4期240-243,共4页Chinese Journal of Medicinal Guide

摘　　要：目的:提高体表心电图对房室旁路定位的正确性,便利心内标测,缩短射频消融时医患受X线照射的时间。方法:样本按每区大于15例设计,全心分10区定位。累积射频消融成功的单支显性旁路277例。采用δ波初始20ms极性、QRS波形态、R/S比值、QRS终末波极性和ST段改变作定位指标。结果:发现心电图在相邻区的旁路有重叠现象,部分区呈一区多样性。本定位规则系统,对单支显性旁路有95.3％的敏感性与99.4％的特异性,诊断正确率99.0％。结论:本定位系统根据预激综合征改变心室除极全过程的原理,采用心室除极的起始波、终末波和复极的ST段定位,并采用一区多标准以适应心电图一区多样性,可从同步6道以上的体表心电图对单支房室旁路作出正确的定位。Objective: Improve the validity of surface electrocardiogram in the localization of accessory pathways, falici-tate endomyocardial identification and shorten the X - ray exposure time of both the doctors and patients. Methods: The whole heart was divided into 10 areas. Totally 277 cases of single accessory pathway who underwent radiofrequency catheter ablation successfully were included. The sample were larger than 15 cases in each area. Polarity of initial 20ms δ wave, configuration of QRS complex, R/S ratio, polarity of end wave of the QRS complex and ST change were emploied as localization index. Results: The characteristic of electrocardiogram was overlapped in adjacent areas and variated in some areas. The sensitivity , specificity and accuracy of this algorithm in localize single accessory pathways were 95.3% , 99.4% and 99.0% separately. Conclusion: Designed according to the theory that the whole course ventricular depolarization is changed in preexcitation syndrome, this algorithm utilizes the intial wave. end wave of ventricular depolarization and ST segment of repolarization to localize the accessory pathway, and also emploies multiple criteria for one area due to the variety of electrocardiogram. Correct localization of single accessory pathway from 6 - synchronous - lead surface electrocardiogram could be achieved with this algorithm.

关 键 词：预激综合征 心电图 房室旁路 导管射频消融 

分 类 号：R541.7[医药卫生—心血管疾病]