隐匿性房室旁道无创性诊断标准的探讨

EVALUATION OF DIAGNOSTIC CRITERIA OF CONCEALED A-V ACCESSARY PATHWAY(CAP) DURING TRANSESOPHAGEAL ATRIAL PACING (TEAP)

报告30例隐性房室旁道所致房室折返性心动过速者,对其食道心房调搏各项诊断指标进行评价,认为这是一种有较大价值的无创性检查手段,并对PR/RP比值、P_(V1)-P_E、RP_E时距等指标提出了新的见解。

Thirty Cases of atrio-ventricular reciprocating tachycardia (AVRT) using a CAP diagnosed by TEAP were reported. They constituted 21.3% of the SVT seen in the same period. All the tachycardia could be initiated and terminated reproducibly by electrical stimuli. The ECO pattern showed 'a retrograde P wave after QRS complex.' type with the 1st PR Interval less than 0.25 sec. and an average heart rate of 189±32 bpm. The incidences of QRS alternans and functional BBB were 46.7 and 30%, respectively. Both were significantly higher than those in AVNRT (P<0.001). The functional BBB was closely related to the rapid heart rate. In 54 cases with AVRT using a left sided AP (including 28 cases of CAP and 26 cases of Type-A preexcitation), the RPE and PE-Pv, intervals were 121±19 and 67±22 nis, respectively. The authors suggest that RPE 85 ms and PE-PV1 25 ms might be used as the lower limit to identify AVRT from AVNRT, and point out that the criterion of PR/RP >1 can only be used in the esophageal lead but not in . lead V,. The authors believe that most of the AVRT using a CAP could be diagnosed by TEAP.