右心房上部心律的确诊

Diagnosis of high right atrial rhythm

为探讨右心房上部心律的诊断方法,通过动物实验自身对照,同步记录15只犬心电图Ⅱ,aVR导联、心腔内窦房结电图、高位右心房电图。结果发现在窦房结局部注入维拉帕米、石碳酸及电刺激右侧颈迷走神经情况下,窦房结功能被抑制后出现房性逸搏心律时,心电图有时仍为窦性心律(P_1直立、P_aVR倒置);而窦房结电图上则记录不到窦房结电位,心率亦有明显降低(t=2.420,P<0.05)。提示窦房结附近的右心房上部心律仅凭心电图易引起误诊;而窦房结电图则能明确心搏的起源,高位右心房电图则可判定心房搏动的部位。

To investigate diagnostic method of high right atrialrhythm, by comparison between their resultes of animal experiments, authors recorded changes in lead Ⅱ and aVR of ECG, endocardial sinus node electrogram (SNEe) and high right atrial electrogram (HRAE) in anaethetic dogs during injection of Ver-apamil, phenol into their sinus nodes (SN) to stimulate right cervical vagal nerve and found: When function of SN was normal, there was sinus node potential (SNP) prior to atrial wave on SNEe but there was no SNP on HRAE. P wave was positive on lead Ⅱ and negative on lead aVR of ECG. When function of SN was restrained or damaged by drugs, SNP on SNEe vanished but P wave was still positive on lead Ⅱ and negative on aVR in some dogs. ECG might lead us to misdiagnosis sometimes. This study suggests that difference between sinus rhythm and atrial rhythm can't be distinguished only by ECG record, but we can diagnose it easily on SNEe.