食管导联心电图鉴别快速性心律失常

The clinical application value of bipolar esophageal electrocardiogram in the differential diagnoses of tachyarrhythmia

目的 评价食管导联心电图在快速型心律失常鉴别诊断中的临床应用价值.方法 入选于2009年9月至2012年12月在我院门诊或住院患者中因为有心慌、头晕或晕厥等临床症状就诊的患者,体表心电图提示为快速型心律失常的患者38例,同步描记食管和体表心电图,通过综合分析和精确测量明确诊断心律失常的电生理类型,采取对应处理策略,观察疗效,进行评价.结果 ①共计患者38例,年龄15～97岁,平均（46.3±16.2）岁,男性20例（52.6％）例,女性18（47.4％）例.其中汉族26人,回族6人,哈萨克族5人,乌孜别克族1人;②38例患者中包括房室结双径路20（52.6％）例,男性10（50％）例;房室旁路12（31.6％）例,男性7（58.3％）例,其中短PR间期综合征1（8.3％）例男性,显性预激2（16.7％）例男性;房性心动过速4（10.5％）例,其中短阵房速女性3（75％）例,房扑男性1（25％）例;室性心动过速2（3.1％）例男性;③38例患者中确诊为房室结双径路者包括1例97岁合并病态窦房结综合征男性,1例为孕28周40岁高龄孕妇,确诊为房室旁路者中包括1例62岁合并肾衰竭女性,均行超速起搏成功复律;确诊为短阵房速者未予特殊处理自行转复,确诊为房扑者为1例58岁男性,合并高血压性心脏病,给予静脉注射维拉帕米后心室率得以控制后心律自行转复;确诊为室性心动过速者,1例为38岁无器质性心脏病,给予静脉注射胺碘酮成功复律,1例为70岁,合并高血压、心功能不全,因血流动力学不稳定,行电复律成功.结论 ①食管导联心电图有助于快速型心律失常常见类型的鉴别诊断,尤其对阵发性室上性心动过速的常见类型如房室结双径路或房室旁路以及室性心动过速具有诊断价值;②根据诊断结果指导临床采取正确、有效的处理策略,收到良好效益,适宜在临床,尤其在基层医院广泛开展。

Objective The purpose of this study is to evaluate the chnical application value of bipolar esophageal electrocardiogram（BEE） in the differential diagnoses of tachyarrhythmia. Methods 38 cases were selected from the outpatient and hospitalized patients in our hospital from September 2009 to December 2012,with palpitations, dizziness, syncope and other clinical symptoms, body-surface electrocardiogram showed tachyarrhythmia, simultaneous recordings of BEE and on the basis of accurate measurement and comprehensive analysis,the author diagnosed the auarrhythmia electrophysiological type, adopted corresponding treatment strategies, observed and evaluated effects. Results ①A total of 38 patients, aged 15 - 97 years old, the mean （46.3 ± 16.2） years old, 20 （52.6%） cases of male, 18（47.4%） cases of female, including 26 cases ofhan nationality, 6 hui, 5 kazak and 1 uzbeks; ②Including 20（52.6%） cases of dual atrioventricular nodal pathways （DAVNP） among 38 patients, 10（50%） cases of male; 12 （31.6%） cases of atrioventricular bypass, 7 （58.3%） cases of male, 1 （8.3%） cases of male short PR interval period syndrome, 2（16.7%） cases of male manifest pre-excitation syndrome; 4（10.5%） cases of atrial tachycardia（AT）, 3（75%） cases of female transitory atrial tachycardia, 1 （25%） cases of male atrial flutter, 2（3.1%）cases of male ventricular tachycardia （VT）; ③Among 38 cases of patients, diagnosed with DAVNP, one case of 97-year-old male with sick sinus syndrome （SSS）, 1 case of 40-year-old pregnant female for the 28th week of gestation; Diagnosed with atrioventricular bypass,one case of 62- year-old female with kidney failure,all of them received overdrivel pacing successfully; 3（75%） cases of female diagnosed with transitory atrial tachycardia healed themselves without any special treatment, 1 case of 58-year-old male with hypertensive heart disease received intravenous verapamil, and his ventricular rate was controled and then converted; Diagnosed with VT, 1 case of 38-year-old male without organic heart disease received intravenous amiodarone, then obtained normal heart rhythm, one 70-year-old male with hypertension, cardiac dysfunction,hemodynamic instability, was taken electrical cardioversion successfully. Conclusions ① Bipolar esophageal electrocardiogram contribute to the differential diagnosis of common types of tachyarrhythmia,especially for common types of paroxysmal supraventricular tachycardia（PSVT）, such as DAVNP and atrioventrieular bypass,and VT; ②According to diagnosis guide, clinicians adopted correct and effective treatment strategies, and received a great benefit. The author suggested BEE should be used as in clinical, especially in basic general hospitals.