非折返房性心动过速P波形态的定位诊断

Localization Diagnosis of P Wave Configuration in Non-Reentrant Atrial Tachycardia

目的:通过分析房性心动过速(房速)时心电图P波形态特征判定房速起源。方法:对37例成功行单靶点消融治疗的房速患者的P波形态和参数与消融靶点进行对比分析。计算房速时PR与PP间期比值(PRI)评价激动在房室结传导的时程变化;计算P波与PR间期的比值(PCI)评价激动在房内传导的变化。结果:29例靶点位于右房,8例位于左房。左房房速在下壁导联P波振幅显著增高。右房后壁的PR(I0.52±0.05)数值在各部位中最大,无冠窦、冠状窦口和右房侧壁的PCI(0.24±0.04)值最小。结论:aVL和V1导联P波形态对区分左房和右房房速具有重要的临床意义,Ⅱ、Ⅲ、aVF导联可为起源点位于心房上下提供线索,PRI、PCI有助于房速起源的判定。

Objective： To analyze P wave configuration in patients with atrial tachycardia to differentiate ectopic foci originating in left or right atrium on the basis of surface ECG findings. Methods： A total of 37 patients with atrial tachycardia due to either abnormal automaticity or triggered rhythm underwent detailed atrial endocardial mapping and successful catheter ablation of a single atrial focus. The PRI index （PR interval/PP interval） was calculated to evaluate the variation of conduction upon the atrioventricular node. The PCI index （P width/PR interval） was also calculated to evaluate the variation of intra-atrial conduction. Conclusion： P waves in V1 and aVL were the most helpful in distinguishing right atrial from left atrial foci. Lead Ⅱ,Ⅲ and aVF were helpful in providing clues for differentiating superior from inferior foci. PCI and PRI index was helpful to predict site of tachycardia origin.