经食管电生理检查在阵发性室上性心动过速诊治中的应用价值  

Application value of transesophageal electrophysiologic study in diagnosis and treatment of paroxysmal supraventricular tachycardia

作　　者：杨燕秋[1] 王新康 YANG Yanqiu;WANG Xinkang(Provincial Clinical Medical College,Fujian Medical University;Department of Electrocardiographic Diagnosis,Fujian Provincial Hospital/Provincial Hospital Affiliated to Fuzhou University,Fuzhou Fujian 350001,China)

机构地区：[1]福建医科大学省立临床医学院,福建省立医院(福州大学附属省立医院)心电诊断科,福建福州350001

出　　处：《实用心电学杂志》2024年第6期606-609,共4页Journal of Practical Electrocardiology

基　　金：福建省卫生教育联合攻关项目(2019-WJ-18);福建省财政厅专项课题(闽财指[2023]891号)。

摘　　要：目的探讨经食管电生理检查(transesophageal electrophysiologic study,TEEPS)在阵发性室上性心动过速(paroxysmal supraventricular tachycardia,PSVT)诊治中的应用价值。方法回顾性分析因心悸怀疑PSVT而行TEEPS的371例患者的电生理资料。分析TEEPS对心动过速的检出情况,并统计TEEPS相对于心内电生理检查(intracardiac electrophysiologic study,IEPS)的敏感性、特异性及准确率。结果45.55%(169/371)的患者通过TEEPS检出心动过速,其中,81.07%(137/169)为房室结折返性心动过速(atrioventricular node reentrant tachycardia,AVNRT)和房室折返性心动过速(atrioventricular reentrant tachycardia,AVRT)。运动联合S1S1及S1S2刺激可显著提高PSVT的检出率。以IEPS为金标准,TEEPS诊断PSVT的准确率为95.54%(107/112)。TEEPS诊断AVNRT的敏感性、特异性分别为100%、92.31%;诊断AVRT的敏感性、特异性分别为93.18%、98.53%;诊断房性心动过速的敏感性、特异性分别为71.43%、100%。结论TEEPS安全且有效,能提高PSVT的诊断率,在多种心律失常的诊断中均有较高的敏感性和特异性。Objective To explore the application value of transesophageal electrophysiologic study(TEEPS) in the diagnosis and treatment of patients with paroxysmal supraventricular tachycardia(PSVT).Methods We retrospectively analyzed the electrophysiological data of 371 patients who had been suspected with PSVT due to palpitation and had undergone TEEPS.The detection of tachycardia by using TEEPS was analyzed.The sensitivity,specificity and accuracy rate of TEEPS in contrast to intracardiac electrophysiologic study(IEPS) were statistically calculated.Results There were 45.55%(169/371) of the patients diagnosed with tachycardia by TEEPS,and 81.07%(137/169) of them were diagnosed with atrioventricular node reentrant tachycardia(AVNRT) and atrioventricular reentrant tachycardia(AVRT).Exercise combined with S1S1 and S1S2 stimulations can significantly increase the detection rate of PSVT.With IEPS as the diagnostic gold standard,the diagnostic accuracy rate of TEEPS for PSVT was 95.54%(107/112).The sensitivity and specificity of TEEPS for AVNRT was 100% and 92.31%,respectively;the sensitivity and specificity of TEEPS for AVRT was separately 93.18% and 98.53%;the sensitivity and specificity of TEEPS for atrial tachycardia was separately 71.43% and 100%.Conclusion TEEPS proves to be safe and effective,which could increase the diagnostic rate of PSVT,and has relatively high diagnostic sensitivity and specificity for a variety of arrhythmias.

关 键 词：经食管电生理检查 心内电生理检查 阵发性室上性心动过速 心悸 

分 类 号：R541.71[医药卫生—心血管疾病]