体表心电图对AVRT及AVNRT的诊断价值和方法

Evaluation of the diagnosis of electrocardiogram for AVRT and AVNRT

目的 通过对 ６６ 例房室折返性心动过速及房室结折返性心动过速（ Ａ Ｖ Ｒ Ｔ 及 Ａ Ｖ Ｎ Ｒ Ｔ）体表心电图与心内电生理检查结果对比分析，总结心动过速时体表心电图逆传 Ｐ波（ Ｐ－ ）使 Ｑ Ｒ Ｓ波形改变的规律，从而利于用体表心电图对 Ａ Ｖ Ｎ Ｒ Ｔ 及 Ａ Ｖ Ｒ Ｔ 鉴别诊断。方法 根据心动过速的 Ｐ－ 重叠于 Ｑ Ｒ Ｓ波部位不同，产生与心动过速发作前不同的 Ｑ Ｒ Ｓ形态改变，即以下类型：ａ） Ｑ Ｒ Ｓ形态不变，但其后 Ｓ Ｔ－ Ｔ 上可见明显逆 Ｐ；ｂ） Ｑ Ｒ Ｓ形态不变；ｃ） Ｑ Ｒ Ｓ波终末部改变；ｄ） Ｑ Ｒ Ｓ波起始部改变。结果 经心内电生理检查证实，利用体表心电图诊断 Ａ Ｖ Ｒ Ｔ 及 Ａ Ｖ Ｎ Ｒ Ｔ 的敏感性和持异性分别为 ９６％ 及９３％ 。结论 体表心电图能区分绝大多数 Ａ Ｖ Ｒ Ｔ 及 Ａ Ｖ Ｎ Ｒ Ｔ，其可作为进行射频消融术前的筛选诊断，并对临床选择药物终止心动过速有指导意义。

Objective To evaluate the diagnosis in AVRT and AVNRT with electrocardiagram(ECG),66 Patients ECG was analysied by comparing with electrophysiolagy.When AVRT or AVNRT is onset,the QRS shape will be changed by the retrograde P wave (P -).Methods According to the variation of QRS shape on account of P -location,it was classified as fourtypes.Result According to the rule of the variation of QRS wave,AVRT or AVNRT was diagnosised,which is comfirmed by electrophysiology.The sensitivity and specificity for the diagnosis of AVRT and AVNRT is 96% and 93% respectively.Conclusion Great majority of AVRT and AVNRT can be identified with ECG,and it is simple and rapid methods for the diagnosis of AVRT and AVNRT.