房室结双径路与隐匿性房室旁路体表心电图的观察

Observation of body surface electrocardiograms on dual atrioventricular nodal pathways and concealed accessory atrioventricular pathways

目的:提高体表心电图鉴别室上性心动过速的发生机制以及诊断房室结双径路与隐性旁路的准确率。方法:经射频消融术证实的59例房室结双径路(A组)和40例隐匿性房室旁路(B组)患者,分析其术前窦性心律与室上速的体表心电图,总结具有特异性改变的P-QRS波型。结果:射频消融术前窦性心律下,V1导联呈rSr′,A组6例,B组5例,分别占10.17%和12.50%(P>0.05);但术前窦性心律下V6导联呈qRs,A组仅21例,B组24例,分别占60.00%和35.59%(P<0.05);射频消融术前室上速时12导联体表心电图比较,由于逆P(P′)使V1导联呈rSr′,A组43例,发生率72.88%;B组7例,发生率17.5%(P<0.01)。结论:术前窦性心律时,心电图V6导联qRs三相波形对隐匿性预激诊断特异性强,准确性高。室上速时,V1导联呈rSr′多提示房室结折返性心动过速。

Objective：To observe characteristic changes of electrocardiograms （ECGs） and aim to find a way： to diagnose dual atrioventricular nodal pathways and concealed accessory atrioventricular pathways. Methods：Ninetynine patients who were confirmed by radio frequency catheter ablation were divided into group A （n= 59） with dual atrioventricular nodal pathway and B （n= 40） with concealed accessory atrioventricular pathway. Compared the ECCs during the sinus rhythm and tachycardia period in group A and B. Results：Sinus rhythm,rSr＇ complex in V1 lead,the occurrence rate were 10. 17 % vs 12.5 % （P〉0.05）,qRs complex in V6 lead ;the occurrence rate were 35.60~ vs 60. 00% （P（0. 05）. Tachycardia,the different locations of retrograde p（pi）,QRS wave become rSr＇ in V1 leads,the occurrence rate were 72.88 % vs 17.50 % （P〉0.01）. Conclusion：qRs complex in V6 lead of sinus rhythm trend to diagnose concealed accessory atrioventricular pathway. The specialty and accuracy of rSr＇ complex in V1 lead of tachycardia is high for the diagnosis of dual atrioventricular nodal pathway.