后间隔房室旁路体表心电图的定位诊断

Distinguishing diagnosis of surface electrocardiogram(ECG) for the locating posterior septal atrioventricular accessory pathway in Wolff-Parkinson-White (WPW) sydrone.

目的 探讨预激综合征在左、右及后间隔旁路的位置与体表心电图特征性改变的相关关系。方法 以 80例预激综合征射频消融前后作对照 ,寻找体表心电图的特征性改变与左、右及后间隔旁路位置关系 ,确定体表心电图定位左、右及后间隔旁路的鉴别诊断标准 ,并计算其鉴别诊断的敏感性、特异性和准确率。结果 体表心电图的 8大特征变化与预激左右后间隔旁路定位鉴别诊断有关 ,即 V1 导联 QRS波形态、△波方向 ;△波及 QRS波的额面电轴及二者差值 ; 导联 R/ S波比值 ;胸前导联 R/ S>1的转折点 ;PV1 - PE间距。根据以上 8大特点对术前 80例预激重新定位 ,其鉴别诊断敏感性、特异度及准确率在右后间隔旁路分别是 88.2 %、83.3%和 77.5 % ,而左后间隔是 83.3%、88.2 %、87.5 %。结论 B型预激旁路绝大部分位于右后间隔旁路 ,但也不排除左后间隔旁路 ,尤其是左后旁路预激不完全时可出现 B型预激改变 ,上述体表心电图的 8大特征有助于二者鉴别诊断。

Objective To discuss correlation between posterior septal accessory pathway site of type B WPW and characteristics change of surface electrocardiogram.Methods The results of radiofrequence current ablation (RFCA) of 80 causes tye B WPW on control groups was evaluated to find out relative between characteristics of surface ECG and locating posterior septal accessory pathway site.The distingushing diagnosis of left and right posterior septal accessory pathway was estabished.The sensitivity,specifivity and correct rate were calculated.Results The result showed that the eight characteristics changes of surface ECG,including QRS wave polarity in V 1 lead;delta wave and QRS wave axes in the frontal plane;the angle difference between QRS wave and delta wave axes;the R/S ratio in lead Ⅲ;the R/S>1 ratio in precardiol leads and P V1 -P E interval,were correlation with the localization of left and right posterior septal accessory pathway.According to the eight characteristics of surface ECG we made a set of distinguishing diagnosis,and its sensitivity,sepectivity and correct rate respectively were 88.2%,83.3% and 77.5% in the right posterior septal accessory pathways,83.3%,88.2% and 87.5% in the left posterior septal pathways.Conclusion Although most of accessory pathways in thpe B WPW sydrome were located at right posterior septal,the posibility of left posterior septal accessory pathway still existed,specially when the accessory pathway was part excited which looked like type B WPW syndrome.For all over,most right and left posterior septal accessory pathway could be distinguiched by the eight characteristics change of surface ECG.