食管导联RP′间期差异对三种长RP′心动过速的鉴别诊断价值

The diversity of RP' interval in esophageal lead and its diagnostic significance in differentiating long RP' tachycardias

目的探讨食管导联RP′(RP′E)间期差异在长RP′室上性心动过速(SVT)中的诊断价值。方法107例长RP′的SVT患者,经心腔内电生理(EPS)确诊为:房性心动过速(AT)54例,快-慢型房室结折返性心动过速(F-SAVNRT)41例,持续性交界区反复性心动过速(PJRT)12例。将经食管心房调搏诊断结果与EPS结果进行比较,并计算RP′E间期差异对三种长RP′心动过速的诊断灵敏度、特异度及预测值。结果SVT发作时,三种心动过速的RP′E间期差异分别为35.71±9.76,0和5.63±6.23ms;F-SAVNRT及PJRT的RP′E间期差异与AT比较,差异有显著性(P<0.001)。本组资料显示:AT的判断值为RP′E间期差异≥20ms,PJRT为RP′E间期差异<20ms,且RP′E间期差异>0ms,F-SAVNRT为RP′E间期差异=0ms,其诊断三种心动过速的灵敏度分别为96.30%(52/54)、83.33%(10/12)和100%(41/41),特异度分别为100%(53/53)、97.33%(73/75)和96.97%(64/66),阳性预测值分别为100%(52/52)、83.33%(10/12)和95.34%(41/43),阴性预测值分别为96.36%(53/55)、97.33%(73/75)和100%(64/64)。结论长RP′的SVT发作时,测定RP′E间期差异对AT、F-SAVNRT和PJRT的鉴别诊断具有重要价值。

Objective To evaluate whether the diversity of RP′ interval in esophageal lead （ RP′E ） is helpful in the differential diagnosis of long RP′ supraventricular tachycardias （SVTs）. Methods ECG including an esophageal lead was recorded under sinus rhythm and SVT in 107 patients whose tachycardia was subsequently diagnosed during an electrophysiological study（EPS） as： atrial tachycardia （AT, n = 54） , type ＂fast-slow＂ AV node reentry tachycardia （F-S AVNRT, n = 41 ） and permanent junctional reciprocating tachycardia （ PJRT, n = 12 ）. Diagnoses from esophageal ECG and from EPS were compared in order to evaluate the sensitivity ,specifity and predictive values of the diversity of RP′E in differentiating these three SVTs. Results The diversity of RP′E in the three groups was： 35.71 ± 9.76ms in AT patients, 0ms in F-S AVNRT cases and 5.63 ± 6.23 ms in PJRT individuals. The difference was significant when comparing the latter two groups to the AT group （P 〈0. 001 ）. It is suggested that the cut-off value for the RP′E diversity were 20ms and 0 ms in diagnosing SVT： AT 〉/ 20 ms; PJRT 〈20 ms, but 〉 0 ms; F-S AVNRT = 0 ms. The diagnostic sensitivity of the three tachycardias was 96.30 % （52/54）, 83.33 % （10/12） and 100 % （41/41）. The specificity was 100 % （53/53）, 97. 33 % （73/75）and 96.97 % （64/66）. The positive predictive values were 100% （52/52）, 83.33% （10/12）and 95. 34% （41/43） , and negative predictive values were 96.36% （53/55） , 97.33% （73/75） and 100% （64/64）. Conclusion The results that the diversity of RP′E recording from an esophageal lead is a sensitive and specific index for the differential diagnoses of long RP′ SVTs.