冠状静脉窦不同部位起搏拖带心动过速对房性心动过速的诊断价值  

Diagnostic Value of Entrainment the Tachycardia at Different Sites of Coronary Sinus on Defining the Atrial Tachycardia

作　　者：郭金锐 黄金秋 刘可 郭雨龙 郭涛 姚焰[2] GUO Jinrui;HUANG Jinqiu;LIU Ke;GUO Yulong;GUO Tao;YAO Yan(Arrhythmia Center,Fuwai Yunnan Cardiovascular Hospital,Kunming(650032),Yunnan,China)

机构地区：[1]云南省阜外心血管病医院心律失常中心,昆明市65003 [2]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院心律失常中心

出　　处：《中国循环杂志》2020年第3期271-276,共6页Chinese Circulation Journal

基　　金：云南省科技厅-昆明医科大学应用基础研究联合专项面上项目[2019FE001(-108)];心血管疾病国家重点实验室开放课题(2019kyyf-02)

摘　　要：目的:探讨心动过速时分别在冠状静脉窦近端(CSp)和远端(CSd)快速起搏拖带心动过速的操作方法鉴别房性心动过速(AT)的价值。方法:入选67例室上性心动过速患者,在心动过速时分别以短于心动过速周长10~40 ms的间期起搏CSp和CSd,确认夺获心房后停止起搏。如果心动过速不终止,测量每次起搏停止后的第一个QRS波群起始至第一个自身A波的间期(VA间期),计算两个VA间期差值(DVA)。结果:67例患者平均年龄(41±17)岁,其中15例为AT患者,25例为房室结内折返性心动过速患者,27例为房室折返性心动过速患者(后两类患者为非AT患者)。AT患者的DVA[(79±29)ms]大于非AT患者[(4±2)ms],差异有统计学意义(P<0.01)。所有AT患者的DVA均>10 ms,而非AT患者中无一例DVA>10 ms。结论:在冠状静脉窦不同部位起搏拖带心动过速,计算停止起搏后第一个DVA是一种快速、简单、有效的诊断或除外AT的方法,在使用较少标测电极时更为实用。Objectives:The purpose of this study was to determine whether entrainment the tachycardia at the different sites of coronary sinus can accurately identify or exclude atrial tachycardia(AT)by examining the difference between the VA intervals of the first returning beat of tachycardia between the two pacing sites.Methods:Sixty-seven consecutive patients(mean age[41±17]years)were enrolled in this study.During SVT,overdrive pacing from the CSp was attempted.If the same tachycardia continued,the atrial overdrive pacing was repeated with the same cycle length from the CSd.The VA interval from the QRS following the last conducted paced atrial beat and the first returning spontaneous atrial beat(delta VA)was measured.Results:Among the 67 patients,15 patients were identified with AT,25 patients with atrioventricular nodal re-entry tachycardia(AVNRT),27 patients with atrioventricular re-entry tachycardia(AVRT).There was a highly significant difference on the mean VA interval from the QRS following the last conducted paced atrial beat and the first returning spontaneous atrial beat([4±2]ms[range 1-9 ms]vs[79±29]ms[range 35-136 ms],P<0.01)between the 52 non-AT patients and the 15 AT patients.None of the patients in the non-AT group had a delta VA>10 ms,all 15 patients with AT had a delta VA interval>10 ms.Conclusions:Examining the VA intervals from the QRS following the last conducted paced atrial beat and the first returning spontaneous atrial beat derived from the two coronary sinus pacing sites is an easy and accurate method for the quickly and reliably identification or exclusion of AT,particularly when only a limited number of electrode mapping are used.

关 键 词：房性心动过速 心房快速起搏 阵发性室上性心动过速 冠状静脉窦 

分 类 号：R54[医药卫生—心血管疾病]