伪冠状T_(Ⅱ,Ⅲ,aVF)波诊断折返性室上性心动过速的价值

Value of Pseudo Coronary T_(Ⅱ、Ⅲ、aVF) Wave in the Diagnosis of Reentrant Supraventricular Tachycardia.

回顾性分析 134例射频消融确诊的窄QRS波群室上性心动过速 (SVT)患者窦性心律及心动过速时心电图 ,以评估伪冠状TⅡ、Ⅲ、aVF波在SVT中的鉴别诊断价值。伪冠状TⅡ、Ⅲ、aVF波定义为心动过速时Ⅱ、Ⅲ、aVF导联出现深倒、双支对称T波 ,而窦性心律时T波正常。结果 :10 2例AVRT患者中 2 9例 (2 8% )可见伪冠状TⅡ、Ⅲ、aVF波 ,32例AVNRT患者无 1例有伪冠状TⅡ、Ⅲ、aVF波 (P <0 .0 1)。伪冠状TⅡ、Ⅲ、aVF波诊断AVRT的敏感性为 2 8%、特异性为10 0 %、阳性预测值为 10 0 %。AVRT组中 ,仅后隔旁道可见伪冠状TⅡ、Ⅲ、aVF波 ,伪冠状TⅡ、Ⅲ、aVF波诊断后隔旁道的敏感性为 85 %、特异性 10 0 %、阳性预测值为 10 0 %。结论 :PSVT时伪冠状TⅡ、Ⅲ、aVF波可作为鉴别AVRT和AVNRT的一项心电指标 ,且可用于对旁道的初步定位。逆向心房激动顺序及RP间期可能是产生伪冠状TⅡ、Ⅲ。

This paper is to investigate the value of pseudo coronary T Ⅱ、Ⅲ、aVF waves in the diagnosis of reentrant supraventricular tachycardia.ECG of 134 patients receiving radiofrequency current ablation because of paroxysmal supraventricular tachycardia (PSVT) were analyzed.Pseudo coronary T Ⅱ、Ⅲ、aVF waves are definited that T waves were deeply reversed and symmetry in Ⅱ,Ⅲ,aVF during tachycardia and T waves are normal during sinus arrhythmia.Result:Pseudo coronary T Ⅱ、Ⅲ、aVF waves were seen in 29 patients with atrioventricular reciprocating tachycardia (AVRT) and in none of the patients with atrioventricular nodal tachycaodia (AVNRT).Sensitivity of pseudo coronary T Ⅱ、Ⅲ、aVF waves in the diagnosis of AVRT was 28% and speciality was 100% and positive prognostic value was 100%.During the AVNRT,Only the posterior septal accessory pathway occurred pseudo coronary T Ⅱ、Ⅲ、aVF waves.Sensitivity of pseudo coronary T Ⅱ、Ⅲ、aVF waves in the diagnosis of posterior septal accessory pathway was 85% and speciality was 100% and positive prognostic value was 100%.Conclusion: Pseudo coronary T Ⅱ、Ⅲ、aVF waves during PSVT could distinguish AVNRT from AVRT and confirm accessory pathway site.The mechanism of pseudo coronary T Ⅱ、Ⅲ、aVF waves was reversed atrium exciting.[Chinese Journal of Cardiac Pacing and Electrophysiology,2000,14(3):186～187]