心房不同部位拖带法鉴别不典型房室结折返性心动过速和房性心动过速

The entrainment pacing from different sites of atrium for differential diagnosis of atypical atrioventricular node reentrant tachycardia and atrial tachycardia

目的报道一种鉴别不典型房室结折返性心动过速(AVNRT)和起源点邻近Kock三角的房性心动过速(AT)的新方法。方法 22例室上性心动过速患者,在心房不同部位(右房心耳部、冠状静脉窦近端、远端)起搏拖带心动过速,测定起搏后VA间期(最后一个起搏脉冲前传夺获的心室电图到起搏终止后第一心搏的最早心房电图的距离)。计算各部位起搏后VA间期的差别并取差别绝对数的最大值定义为ΔVA间期。结果 13例AVNRT起搏后ΔVA间期5.8±3.6(0～14)ms,9例AT起搏后ΔVA间期62.8±24.2(21～98)ms。ΔVA间期在所有AVNRT均<15 ms,在所有AT均>15 ms,因此起搏后ΔVA间期>15 ms用于诊断AT的灵敏度和特异度均为100%。结论心房不同部位起搏拖带法可用于准确鉴别不典型AVNRT和起源点邻近Kock三角的AT。

Objective To describe a novel technique for differential diagnosis of atypical atrioventricular node reentrant tachycardia（AVNRT） and atrial tachycardia（AT）originating near Koch′s triangle.Methods Twenty-two supraventricular tachycardias were studied.Entrainment pacing during the tachycardia from 3 different atrial sites（right atrium appendage,proximal and distal coronary sinus） was performed,the maximal difference in the postpacing VA intervals（last captured ventricular electrogram to the earliest atrial electrogram of the initial beat after pacing） among the different pacing sites（delta-VA interval） was calculated.Results The delta-VA intervals were 5.8±3.6（0-14）ms in AVNRT group（n=13）and 62.8±24.2（21-98）ms in AT group（n=9）.The delta-VA intervals were 15 ms in all AT patients and15 ms in all atypical AVNRT patients,thus,the delta-VA interval 15 ms was diagnostic for AT with the sensitivity and specificity values being 100%.Conclusion The entrainment pacing from different sites of atrium is a simple method that can accurately distinguish AT originating near Koch′s triangle from atypical AVNRT.