房室折返性心动过速逆行P波的心电图特征及其在旁道定位中的价值

Electrocardiographic Features of Retrograde P Wave and Its Value for Locating Accessory Pathway in Patients With Reciprocating Tachycardia Utilizing a Retrograde Accessory Pathway

为探讨逆行 P(P′)波对房室旁道(AP)定位的价值,采用食管调搏观测经射频消融的64例(AP 参与的心动过速)患者5个导联上 P′波的极性和振幅、R_E-P′E及 P′_(V′)-P′_E 时距(分别为食管导联 QRS 波与 P′波两起始点之间的时限和 V_1与食管导联两 P′波波峰之间的时限),发:现左右两侧 AP 的 P′_1、P′_(v_1)极性和 P′_(v_1)-P′_E 时距各具特征,相互无重叠,该特征对区别二者有肯定价值;AP 由后向前分布,下壁(Ⅱ,Ⅲ)两导联 P′波的极性从倒置转为直立;倒置且深大的 P′Ⅱ和 P′Ⅲ是诊断后间隔 AP 有价值的指标;R_E-P′_E 和 P′_(V_1)-P′_E 时距则与右侧 AP 的具体部位相关。提示:用食管调搏观察 P′波的各项特征可对 AP 进行定化诊断:左侧 AP 的诊断标准为 P′_1侧置,P′_(V_1)直立,P′_(V_1)-P′_E 时距≤-30 ms;右侧则为 P′_I 直立,P′_(V_1)倒置,P′_(V_11)-P′_E 时距≥0。

To valuate the polarity and amplitude of retrograde P wave(P′),the ventrioatrium interval in esophageal lead(R_E-P′_E) and P′_(V_1)-P′_E distance in locating atrioventricular accessory pathway (AP),the esophageal pacing was performed in 64 patients with reciprocating tachycardia utilizing retrograde AP which was verified by radiofreqency current ablation.The results showed:The Characters that the polarity of P′ in I,V_1 Leads and P′_(V_1)- P′E distance in right AP was different from those in left AP were diagnosis valuable in distinguishing right or left AP;That the polarity of P′ in inferior leads(Ⅱ and Ⅲ leads)changed from negative to positive while localization of AP moving from posterior was helpful to locate actual AP.R_E-P′_E and P′_(V_1)-P′_E distances were related to different localization of right AP.In conclusion,it is possible to locate AP by esophageal pacing and the criteria for locating left AP are negative P′_1,positive P′_(V_1) and P′_(V_1)-P′_E≤-30 ms,for right AP are positive P′(?),negative P′_(V_1) and P′._(V_1)- P′_E interval≥0.