隐匿性房室旁道无创性诊断标准的探讨

Evaluation of Diagnostic Criteria of Concealed A-V Accessary Pathway (CAP) During Transesophageal Atrial Pacing (TEAP)

通过30例隐性房室旁道所致房室折返性心动过速,对食管心房调搏的各项诊断指标进行评价,认为后者是一种有较大价值的无创性检查手段,并对PR/RP比值、Pv_1-PE、RP_E时距等指标提出了新的见解。

30 cases of atrto-ventricular reciprocating tachycardia (AVRT) through CAP diagnosis by TEAP are herein reported. They constituted 21.3% of he SVT seen in the same period. All the tachycardia cases could either be initiated or terminated reproducibly by electrical stimuli. The ECG pattern showed a retrograde-P-wave-after-QRS-complex type with the 1st PR interval below 0.25 sec. and an average heart rate of 189±32 bpm. The incidence of QRS alternant and functional BBB was 46.7% and 30% respectively, both significantly higher than those in AVNRT(P<0.001). The functional BBB was closely related to the rapid heart rate. In 54 cases of AVRT using a leftsided AP (including 28 cases of CAP and 26 cases of Type-A preexcitation), the RPE and PE-PV_1 intervals were 121±19ms and 67±22ms, respectively. The authors suggest the use of RPE 85 ms and PE PV_1 25ms as the lower limit to differentiate AVRT from AVNRT, and have pointed out that the criterion on PR/RP>1 could only be applid to the esophageal lead but not to lead V_1. The authors believe in the correctness of diagnosis for in most of the CAP-caused AVRT through TEAP.