窄QRS波心动过速时ST-T改变的临床意义

The clinical significance of ST-T changes during narrow QRS complex tachycardia

目的 :了解窄QRS波阵发性室上性心动过速 (PSVT)时ST -T改变的临床意义。方法 :分析经食管和 (或 )心内电生理检查的 143例房室折返性心动过速 (AVRT)及 80例慢 快型房室结折返性心动过速 (AVN RT)发作时的体表 12导联心电图。结果 :AVRT组和AVNRT组平均ST段压低幅度分别为 (1.90± 1.6 5 )mm和(1.33± 1.46 )mm (P <0 .0 1) ;AVRT组中ST段压低≥ 2mm和 (或 )T波倒置者有 86例 (6 0 .14% ) ,明显高于AVNRT组的 2 7例 (33 .75 % ) (P <0 .0 0 5 )。此差异不能被心率所矫正。另左前、左侧壁和左后壁旁道参与的AVRT ,其最大ST段压低多分布于V3～V6和V1～V3 导联。结论 :窄QRS波SVT时心电图上ST -T改变可作为鉴别AVRT和慢 快型AVNRT的一个简易、有用指标 。

Objective:To study the clinical significance of ST T changes during norrow QRS complex tachycardia. Methods:The 12 lead ECG data during esophageal electrophysiologic test and radiofrequency catheter ablation were analysed in 143 patients with atrioventricular reentrant tachycardia(AVRT) and 80 patients with slow-fast atrioventricular nodal reentrant tachycardia(AVNRT) .Results:The mean magnitude of ST Segment depression was greater in AVRT than in AVNRT[(1.90±1.65mm VS 1.33±1.46mm,P< 0.01)]. ST segment depression ≥2mm or T wave inversion or both occured more often in AVRT than in AVNRT [60.14% (86/143) VS 33.75 %( 27/80), P< 0. 005]. This difference can't be corrected by heart rate. The leads of ST segment depression among the left anterolateral wall and the left lateral wall accessory pathways frequently appeared in ranged V 3 to V 6 leads. The leads of ST segment depression among the posterolateral wall accessory pathways frequently appeared in ranged V 1 to V 3 leads.Conclusion:ST T changes during narrow QRS complex tachycardia is a useful index to differentiate AVRT from slow fast AVNRT, and it is helpful to locate the accessory pathway.