双极食管心电图对间隔部隐匿性旁路的诊断价值

Diagnostic value of bipolar esophageal electrocardiogram in septal dormant atrioventricular accessory pathway

目的比较单极食管心电图和双极食管心电图对间隔部隐匿性旁路的诊断价值。方法选择经心内电生理检查和射频消融术证实的19例间隔部隐匿性旁路患者。消融术前经食管心房调搏诱发阵发性室上性心动过速发作,记录发作前后体表12导联心电图、单极食管心电图、双极食管心电图。分别观察P波形态、极性、P波与QRS波群关系,测量P波振幅、时限,以心内电生理检查结果为标准分析单极食管心电图和双极食管心电图对间隔部隐匿性旁路的诊断率差异。结果单极食管心电图P波无极性变化,双极食管心电图P波可根据需要调整极性。双极食管心电图和单极食管心电图的P波振幅分别为(0.58±0.12)mV和(0.36±0.11)mV(P<0.05),P波时限分别为(96±11)ms和(99±14)ms。单极食管心电图和双极食管心电图对间隔部隐匿性旁路的诊断符合率分别为58%和89%(P<0.05)。结论双极食管心电图记录的P波振幅大于单极食管心电图,并能更清晰的显示P波、P波和QRS之间的关系,对间隔部隐匿性旁路的诊断优于单极食管心电图。

AIM To evaluate the diagnostic value of bipolar esophageal electrocardiogram in septal dormant atrioventricular accessory pathway. METHODS Nineteen patients with septal dormant atrioventricular accessory pathway, diagnosed by electrophysiological study and radiofrequency ablation, were chosen to receive transoesophageal atrial pacing to induce the onset of paroxysmal superventricular tachy- cardia （PSVT）. The 12 leads superficial ECG, unipolar and bipolar esophageal ECG were recorded during the whole process of transoesophageal electrophysiological study. The shape and polarity of P wave and the relationship between P wave and QRS complex were observed in each ECG. The duration and voltage of P wave were measured and the difference of the diagnosis veracity of the septal dormant atrio- ventricular accessory pathway was compared between the unipolar and bipolar esophageal ECG using the results obtained by the invasive electrophysiological mapping as the golden standard. RESULTS There was no polar change of P wave in unipolar esophageal ECG while the polarity of P wave could be adjusted according to the need in the bipolar ECG. between the unipolar and bipolar esophageal Though the duration of P wave had no statistical difference ECG （96 ± 11 ） ms vs （99 ±14） ms, the voltage of P wave was statistical higher in bipolar esophageal ECG than that in unipolar esophageal ECG （0.58 ±0.12） mV vs （0.36 ± 0.11 ） mV, P 〈 0. 05 ）. With the results obtained from electrophysiological studies as the standard, the diagnostic veracity of septal dormant atrioventricular accessory pathway of unipolar and bipolar esophageal ECG is mo ECG were 58% and 89% respectively （P 〈0. 05）. CONCLUSION The bipolar esophageal re reliable than unipolar esophageal ECG in the diagnosis of septal dormant atrioventricular accessory pathway, because the former can record the P wave with higher voltage and displays the P waves more clearly.