冠状静脉源性显性旁道体表心电图特征分析

Analysis of Electrocardiogram Characteristics in Patients With Coronary Venous Dominant Accessory Pathway

目的:从经射频消融术确诊的右后间隔显性旁道病例中,回顾性分析冠状静脉源性显性旁道的体表心电图特点,为冠状静脉源性显性旁道体表心电图定位提供依据。方法:纳入2008-01至2013-05在福建省立医院行射频消融治疗的显性右后间隔旁道的96例住院患者作为受试对象。以射频消融术结果为标准,分析术前心电图相关特征对冠状静脉源性显性旁路定位的符合程度。结果:96例右后间隔显性旁道患者中,冠状静脉源性显性旁道有11例,其中8例是冠状窦口旁道,3例是心中静脉显性旁道。在冠状窦口显性旁道8例中,Ⅱ导联δ波均显著负向,呈QS型。在心中静脉显性旁道3例中,Ⅱ导联δ波没有显著负向,呈qrS型。冠状静脉源性显性旁道中,胸前导联移行在V2导联有10例。Ⅱ导联δ波显著负向,冠状静脉源性显性旁道敏感性为72.7%(8/11),特异性为80%(68/85);移行在V2导联,且Ⅱ导联δ波显著负向,冠状静脉源性显性旁道敏感性为63.6%(7/11),特异性为100%(85/85)。结论:右后间隔显性旁道体表心电图同时具备胸前导联R/S比值>1的移行带在V2导联、Ⅱ导联δ波显著负向这两个特征,高度提示旁道位于冠状静脉,且多是冠状窦口。

Objective： To analyze the electrocardiogram （ECG） characteristics in patients with coronary venous dominant accessory pathway （CVDAP） in order to provide the basis for surface ECG positioning in those patients. Methods： We retrospectively studied 96 patients with right posterior septal dominant accessory pathway and successfully underwent radiofrequency ablation （RFA） in our hospital from 2008-01to 2013-05. Taking RFA result as the standard, we analyzed the coincidence degree of pre-operative ECG characteristics for CVDAP diagnosis. Results： There were 11/96 patients with coronary vein dominant AP containing 8 of orifice of coronary sinus dominant AP and 3 of middle cardiac vein dominant AP. In those 8 patients, the ECG lead II showed prominent negative 8 wave, and with Qs model. In those 3 patients, the ECG 8 wave was not prominent negative, and with qrS model. There were 10 CVDAP patients with ECG precordial leads migration zone at lead Vv With the characteristic of lead II at prominent negative ~ wave, the sensitivity for ECG diagnosing CVDAP was at 72.7% （8/11）, specificity was at 80% （68/85）; with the characteristic of migration zone at lead V2 and lead II showing prominent negative δ wave, the sensitivity for ECG diagnosing CVDAP was at 63.6% （7/11）, specificity was at 100% （85/85）. Conclusion： In patients with right posterior septal dominant accessory pathway, when ECG showing precordial leads R/S ratio〉l in lead V2, and prominent negative 8 wave in lead II at the same time, then the accessory pathway was highly likely in coronary vein, specially at the orifice of coronary sinus.