心室拖带中的室性融合波逆传心房对隐匿性间隔旁诊断价值的研究

The value of converse conduction to atrium at ventricular entrainment on the diagnosis of concealed septal accessory pathways

目的探讨能够快速、准确鉴别室房传导途径的简便方法。方法选择射频消融(RFCA)的阵发性室上性心动过速(PSVT)患者共55例,55例患者在心动过速发作时,心内膜标测心房逆传激动顺序均为向心性分布,诱发心动过速后,以快于心动过速10～20次/min的频率起搏心室(RV)、观察心室被起搏刺激完全夺获之前的心室融合波是否伴有心房激动的提前或延迟,若有可诊断为间隔旁道逆传参与的房性折返性心动过速(AVRT),若无即可排除AVRT。结果心室拖带中室性融合波发生心房逆传,诊断间隔旁道参与的AVRT的敏感性为85.71%,特异性为91.89%,阳性预测值为100%,阴性预测值为91.89%,临床准确性为94.55%。结论心室拖带中室性融合波逆传心房是一种诊断间隔旁道参与的AVRT的重要方法,而且简便快捷、准确性高,值得临床推广应用。

Objective To evaluate the value of atrium conversing conduction modification at ventricular entrainment on the diagnosis of concealed septal accessory pathways Methods Fifty five patients with paroxysmal supraventricular tachycardia （PSVT） undergoing radiofrequency catheter ablation （RFCA） were studied. After induction of the tachycardia, right ventricular was paced at a frequency 10-20 beats/rain, faster than the ventricular rate. Observe whether atrial excitation delayed or was ahead of schedule at ventricular entrainment, when the fusion complexes appeared. If so, septal accessory pathways could be diagnosed. Results Using this criteria, the sensitivity, specificity, positive predictive value, negative predictive value, and clinical accuracy for diagnosis septal accessory pathways with AVRT was 85.71%, 91.89%, 100%, 91.89% and 94.55% respectively. Conclusion Atrium conversing conduction modification at ventricular entrainment is a simple, accurate and worthwhile method in the diagnosis of septal accessory pathways.