房室结/隐匿性旁道折返性心动过速食管调搏诊断指标的评价

Evaluation of diagnostic criteria of atrioventricular nodal /con- cealed bypass tract reentrant tachycardia during transesophageal atrial pacing (TEAP)

为提高食管调搏对折返性心动过速的诊断准确率,对30例房室结折返性心动过速和35例隐匿性旁道折返性心动过速作食管调搏(该65例诊断结果与射频消蚀诊断一致率为98.5%).结果显示:电刺激重复诱发和终止以及心动过速时R-P/P-R<1诊断两型的必备指标;室上速第1个P-R间期<240ms、房室结双径路、R-P间期<70ms或>95ms、P_(v_1)-P_E时距≥25ms、P与QRS重叠、QRS后逆行P等是鉴别两型的综合指标.认为食管调搏多指标综合分析对诊断两型折返性心动过速及指导治疗有重要意义.

To raise accuracy rate of reentrant tachycardia diagnosed by TEAP, 30 cases with typical A-V nodal reentrant tachycardia and 35 cases with fast conducting concealed bypass tract reentrant tachycardia were studied by TEAP [The diagnosis of TEAP co- incided with that of radiofrequency ablation in 64 of the 65 patients (98. 5%)]. Results showed that their necessary diagnostic criteria were tachycardia initiated and terminated reproducibly by electrical stimuli and R-P/P-R<1 during tachycardia, and their differential diagnostic criteria included the first P-R interval of tachycardia≤240ms, dual A-V nodal pathways, P wave superimposed QRS wave, retrograde P wave separated from QRS wave, RP interval <70ms or >95ms, Pv2 -PE≥25ms, and so on. A synthetical analysis of multiple criteria of TEAP may be helpful in differentiation of two types of reentrant tachycardia and guiding their therapy.