食道单极心房电图在鉴别房室结折返和有左侧旁道参与的房室折返中的意义

The Significance of Esophageal Unipolar Atrial-electrogram in Differential Diagnosis of A-V Node Reentry wtih or without Left Accessory Pathway

将食道心房调搏诱发的阵发性室上性心动过速(PSVT)17例分为Ⅰ(WPW,左侧旁道)、Ⅱ(双径)和Ⅲ(既无WPW也无双径,且在调搏时亦不出现预激图形)共3组。并同步记录V_1、V_E导联。结果发现:房室结双径折返的PSVT特征是V_E近、远端图形颠倒,A峰或超前、或滞后或重叠于P^-峰,两峰相距很近,A峰与P^-峰的间距≤40ms。如房波与QRS重合更是重要的特征。左侧旁道参与折返的PSVT,其A峰-P^-峰≥55ms,V_E近、远端图形颠倒,远端A峰依次超前于近端A峰及P^-峰。如果窦律时及心房调搏时均不出现预激图形,可据此诊断为左侧隐匿性旁道。

In seventeen cases, the esophageal unipolar atrial-electrogram(EUAE) and lead V_1 electrocardiogram were recorded simultaneously during supraventricular tachycardia induced by transesophageal atrial pacing. In A-V node reentry patients, EUAE patterns of the proximal end and distal end were reversed, the Ap might appear before, behind the Pp^- or superimposed on the Pp^-,and the Ap-Pp^- intervals were always≤40ms. In the cases of reentry with left-side A-V pathway participation, the distal Ap and distal Ap appeared consistently before the Pp^- and proximal Ap, and the Ap-Pp^- intervals were always≥55 ms with significant statistic difference to that of A-V node reentry patients. It will be used for diagnosis of concealed left A-V pathway if there is no ventricular preexcitation wave during sinus rhythm and atrial pacing.