隐匿性房室旁道心电图定位的临床研究

A Study of Concealed Accessory Atrioventricular Pathways ECG Localization

目的 探讨通过心电图进行隐匿性房室旁道定位. 方法回顾性分析36例经射频导管消融证实为隐匿性房室旁道患者术前的顺向性房室折返性心动过速心电图. 结果通过分析P-波形态与R-Pˉ间期改变,可将旁道初步分为右前、右后、左前、左后4个部位.①V1的Pˉ波倒置时旁道位于右侧,Pˉ波直立时旁道位于左侧,V,的R-Pˉ间期≥P^-R间期时提示旁道位于左前区域.②ⅡⅢ、aVF的Pˉ波直立时旁道位置靠前,倒置时旁道位置靠后;左侧旁道的Ⅲ Pˉ波电压高于aVF时旁道位于左前区域,右侧旁道的Ⅱ Pˉ波电压高于Ⅲ时旁道位于右前区域;Pˉ波深倒置为后间隔旁道特征性表现.⑧Ⅰ、aVL的Pˉ波直立时旁道位于右侧或间隔部,Pˉ波倒置时旁道位于左前区域,Pˉ波倒置越深旁道越靠前.结论 隐匿性旁道逆传形成的Pˉ波形态及V1 R-Pˉ间期改变可对房室旁道定位,不同导联的特征性Pˉ波越多.旁道定位越准确.

Objective To determine site of retrograde accessory pathway （AP） by electrocardiogram. Methods Electrocardiograms recorded during orthoadromic atrioventricular reentrant tachycardia before catheter ablation were analyzed retrospectively in 36 cases with retrograde AP. Results AP location was primarily determined based on the morphology of retrograde P wave （P-） and R- P-interval. Inverted or upright P- wave in lead V1 was corresponding to right or left AP, respectively. R- P- interval ≥ P- -R interval in lead V~ was seen in left anterior AP. Upright or inverted P- wave＇ in lead II, III and aVF indicated that AP located anteriorly or posteriorly, respectively. Amplitude of P- wave was higher in lead III than aVF in left anterior AP, and higher in lead II than III in right anterior AP. Deeply inverted P- wave was the characteristics finding of posteroseptal AP. Upright P- wave in lead I and aVL indicated right or septal AP, white inverted P- wave left anterior AP. The more deep P- wave inverted, the more forward AP located. Conclusion R- P- interval in lead V~ and P- wave morphology may be used to determine site of retrograde AP. The more the characteristics findings of P- wave in various leads, the more precise the location of AP.