房室结折返性与隐匿性旁道参与的房室折返性心动过速的体表心电图诊断  

Electrocardiographie diagnosis of AVNRT and AVRT

作　　者：鲜玉琼[1] 许原[2] 郭继鸿[2] 

机构地区：[1]上海市第七人民医院心内科,200137 [2]北京大学附属人民医院电生理室

出　　处：《上海医学》2002年第1期36-38,共3页Shanghai Medical Journal

摘　　要：目的　探讨体表心电图对房室结折返性心动过速 (AVNRT)及隐匿性旁道参与的房室折返性心动过速 (AVRT)的诊断方法和价值。方法　对已经心内电生理检查确诊的 88例AVNRT和AVRT患者的窦律下与心动过速发作时的体表心电图进行对照研究。结果　 (1)有明确的与QRS波分开的P′波 ,且 1/ 2R R >R P′>70ms者多为AVRT。 (2 )R P′ <70ms ,P′波与QRS波部分重叠 ,致使QRS波后半部分出现假S波或假r′波 ,或P′波与QRS波完全重叠 ,而无法分辨P′波者为AVNRT。 (3)通过心率快慢 ,心动过速发作与窦律下QRS波振幅差别可能无助于AVRT和AVNRT的鉴别。 (4 )对心动过速时P′波明显或伴束支阻滞的AVRT ,可尝试用V1及V6导联R P′间期差别、P′波极性或利用Coumel定律进行旁道定位。结论　简单快捷的体表心电图对AVNRT和AVRT具有重要的诊断价值。Objective To evaluate the diagnostic value of ECG in atrioventricular node reentrant tachycardia (AVNRT) and atrio ventricular reentrant tachycardia (AVRT) with concealed accessory pathway Methods Electrocardiograms of 88 patients with AVRT and AVNRT confirmed by electrophysiology were studied. Results (1) There were obvious P′separated from QRS and 1/2R R>R P′>70 ms in AVRT. (2) In AVNRT, there were R P′<70 ms, parial overlap of P′ and QRS resulting in 's' or 'r′' wave behind QRS, or complete overlap of P′ and QRS will leading to difficult dicrimination of P′ from QRS. (3) Heart rate and difference in amplitude of QRS wave did not help to distinguish AVRT from AVNRT. (4)R P′ interval of lead V 1 and V 6, polarity of P′ wave and Coumel Slama law might be used to locate the site of accessory pathway when obvious P′wave or bundle branch block were pres&nt. Conclusion 12 lead ECG is a simple and rapid method. and has diagnostic value in differentiation of AVRT from AVNRT.

关 键 词：体表心电图 诊断 房室结折返性心动过速 隐匿旁道 房室折返性心动过速 AVNRT AVRT 

分 类 号：R540.41[医药卫生—心血管疾病]