探讨aVR导联ST段抬高对PSVT的鉴别及旁道定位的价值

To Evaluate the value of ST-segment Elevation in Lead aVR for Differentiating Paroxysmal Supraventricular Tachycardia and Determining the Site of Accessory Pathway

房室折返性心动过速（AVRT）和房室结折返性心动过速（AVNRT）是阵发性室上性心动过速（PSVT）中最常见的两种类型,共约占PSVT85%以上,鉴别两种心动过速对于确定射频消融部位有着重要的作用,而STaVR段在分析PSVT心电图时常常被忽略,我们通过对STaVR段抬高探讨其对AVRT与AVNRT的鉴别作用,以及测量STaVR段及STⅡ、Ⅲ、aVF段改变情况,对旁道初步定位起到参考作用。

Objective To evaluate the value of ST-segment elevation in lead AVR for differentiating paroxysmal supraventricular tachycardia（PSVT） and determining the site of accessory pathway（AP）.Methods A total of 164 12-lead electrocardiograms during PSVT induced by transesophageal atrial pacing were analyzed,PSVT was demonstrated by a cardiac electrophysiologic study and radiofrequency catheter ablation.Among them,84 cases were atriolventricular reciprocating tachycardia（AVRT） and 80 cases were atriolventricular nodal reentrant tachycardia（AVNRT）.The differentiation of ST-segment during PSVT and sinus rhythm was analyzed.Results There were 54 cases of AVRT and 21 cases of AVNRT with lead AVR ST-segment elevation≥0.10mV.Taking lead AVR ST-segment elevation≥0.10mV as a standard,the sensitivity,specificity,and exactivity in lead AVR to differentiate AVRT were 64.3%,73.8% and 72.0%,respectively.There were 44 cases with ST-segment decreased ≥0.20mV in Ⅱ、Ⅲ and aVF leads,including of 24 cases of posterior septal.Among 54 cases of AVRT with ST-segment elevation in AVR lead,there were 39 cases in left side.The sensitivity,specificity,and exactivity of ST-segment elevation in AVR lead to localize left side and posterior septal were significantly higher.Conclusions ST-segment elevation in lead AVR is a helpful parameter in differentiating AVRT from AVNRT.ST-segment in lead AVR and ST-segment in Ⅱ、Ⅲ and aVF leads are useful to determining the primary site of accessory pathway.