食道心房调搏检查诊断阵发性室上性心动过速的价值  

作　　者：章晨 郭露燕 包程鸿 潘轶斌 

机构地区：[1]浙江大学医学院附属金华医院,321000

出　　处：《浙江临床医学》2023年第11期1689-1691,共3页Zhejiang Clinical Medical Journal

基　　金：浙江省公益基金研究项目社会发展领域项目(LGF21H020003)。

摘　　要：目的比较食道心房调搏(TEAP)与心内电生理检查(EPS)诊断阵发性室上性心动过速(PSVT)的价值,分析其影响因素。方法回顾性分析2017年1月至2022年3月因PSVT入院,完成TEAP、EPS及射频消融的患者436例。按检查前短期内[(2.17±1.63)d]是否使用过静脉抗心律失常药物,分为用药组和未用药组;PSVT按类型分为房室结双径路、左侧旁道、右侧旁道;按刺激方法分为TEAP和EPS;以最终成功消融靶点作为PSVT分型金标准。结果未用药组TEAP诱发率(72%)与用药组(56.5%)比较,差异有统计学意义(P<0.05)。TEAP对双径路、左侧旁道、右侧旁道的诱发差异有统计学意义(P<0.05);TEAP诱发率与EPS比较,差异有统计学意义(P<0.05);TEAP诊断PSVT的准确性83.9%。异丙肾上腺素可提高EPS的诱发率从76.8%至94.7%。结论TEAP是术前诊断PSVT的有效方法,静脉抗心律失常药物停用超过5个半衰期后仍对TEAP诱发有一定影响,异丙肾上腺素可提高EPS的诱发率。Objective To compare the value and influencing factors of esophageal atrial pacing(TEAP)and intracardiac electrophysiological examination(EPS)in the diagnosis of parparal ventricular hypervelocity(PSVT).Methods A retrospective analysis was performed on 436 patients who underwent TEAP,EPS and radiofrequency ablation due to PSVT from January 2017 to March 2022.According to whether intravenous antiarrhythmic drugs had been used in the short time(2.17±1.63)d before the examination,the patients were divided into the medication group and the non-medication group,among which medication group had stopped more than 5 half-lives before examination.PSVT was divided into two atrioventricular node paths,left side bypass and right side bypass.According to the stimulation method,they were divided into TEAP and EPS.The final successful ablation target was used as the gold standard for PSVT typing.Results There was a statistically significant difference in TEAP induction rate between the untreated group(72%)and the treated group(56.5%)(P<0.05).There was a statistically significant difference(P<0.05)in the induction of TEAP on dual pathway,left side pathway,and right side pathway.The difference in TEAP induction rate compared to EPS was statistically significant(P<0.05).The accuracy of TEAP in diagnosing PSVT was 83.9%.Isoprenephrine can increase the induction rate of EPS from 76.8%to 94.7%.Conclusion TEAP is an effective method for preoperative diagnosis of PSVT.Withdrawal of intravenous antiarrhythmic drugs over 5 half-life periods still has a certain effect on TEAP induction.Isoproterenol can improve the induction rate of EPS.

关 键 词：阵发性室上性心动过速 食道心房调搏 心内电生理检查 射频消融 

分 类 号：R541.71[医药卫生—心血管疾病]