SA-VA间期对阵发性室上性心动过速的鉴别价值  

The value of SA-VA interval in making differential diagnosis of paroxysmal supraventricular tachycardia

作　　者：朱春瑜[1] 林春艺[1] 叶子聪 郑桂安[1] 林珊婴 翁兰[1] Zhu Chun-yu;Lin Chun-yi;Ye Zi-cong;Zheng Gui-an;Lin Shan-ying;Weng Lan(Department of Cardiology, Zhangzhou Municipal Hospital, Zhangzhou Fujian 363000, China)

机构地区：[1]漳州市医院心血管内科,福建漳州363000

出　　处：《实用心电学杂志》2019年第1期27-34,共8页Journal of Practical Electrocardiology

基　　金：福建省自然科学基金资助项目(2016J01486)

摘　　要：目的探讨右室基底段心室拖带时刺激-心房(SA)间期与原心动过速时心室-心房(VA)间期的差值,即SA-VA间期对房室折返性心动过速(atrioventricular reentrant tachycardia,AVRT)与房室结折返性心动过速(atrioventricular nodal reentrant tachycardia,AVNRT)的鉴别价值。方法选取67例体表心电图无明显预激波的窄QRS心动过速患者,在右室基底段拖带心动过速。测量SA-VA间期、拖带后校正回归间期(即校正的起搏后间期与心动过速周长的差值)等电生理参数,并比较其鉴别阵发性室上性心动过速机制的有效性。结果旁道介导AVRT共19例,其中游离壁旁道13例,间隔旁道6例; AVNRT共48例,其中典型35例,不典型13例。校正回归间期> 95 ms诊断AVNRT和AVRT的敏感性、特异性、阳性预测值和阴性预测值分别为90%、90%、96%和78%;而SA-VA间期> 80 ms诊断二者的敏感性、特异性、阳性预测值和阴性预测值分别为94%、84%、94%和85%。其中SA-VA间期≤50 ms鉴别间隔旁道介导AVRT和不典型AVNRT的敏感性、特异性均能达到100%。结论在右室基底段心室拖带下,SA-VA间期能够简便、有效地鉴别AVRT与AVNRT。Objective To discuss the value of the difference of pacing entrained stimulus-auricle(SA) interval and tachycardia ventriculoatrial(VA) interval, that is, SA-VA interval, on differentiating between atrioventricular reentrant tachycardia(AVRT) and atrioventricular nodal reentrant tachycardia(AVNRT), during the tachycardia entrainment through trains of the basal segment of right ventricle.Methods[WT] We selected 67 patients with tachycardia and narrow QRS without obvious preexcitation wave on surface ECG. Tachycardia entrainment was attempted through trains of the basal segment of right ventricle. The electrophysiological parameters including SA-VA interval and the corrected regression cycle (the difference of corrected post-pacing interval and tachycardia circle length) after the entrainment were measured, and their efficacy of distinguishing between different mechanisms of paroxysmal supraventricular tachycardia was compared. Results There were 19 patients with accessory pathway mediated AVRT, using free-wall or septal accessory pathways ( n=13, 6), respectively. There were 48 AVNRT patients in whom 35 were typical and 13 were atypical. The sensitivity, specificity, and positive and negative predictive values of the corrected regression cycle >95 ms were separately 90%, 90%, 96% and 78% in differentiating between AVNRT and AVRT;however, these values were separately 94%, 84%, 94% and 85% for SA-VA interval > 80 ms. And in the differential diagnosis of septal accessory pathway mediated AVRT and atypical AVNRT, the sensitivity and specificity of SA-VA interval≤50 ms could both reach as high as 100%. Conclusion SA-VA interval serves as an easy, simple and effective method for differentiating AVRT from AVNRT during the entrainment through trains of the basal segment of right ventricle.

关 键 词：室房间期 阵发性室上性心动过速 房室折返性心动过速 房室结折返性心动过速 心室拖带 

分 类 号：R541.71[医药卫生—心血管疾病]