食道导联心电图鉴别诊断宽QRS心动过速的临床应用

The Clinical Application Value of Esophageal Electrophysiologic Study in Diagnosis of Wide QRS Complex Tachycardia

目的应用食道导联心电图对宽QRS心动过速(WCT)进行鉴别诊断.方法对62例WCT急性发作患者插入食道电极,描记并分析食道导联心电图,明确诊断.结果 44例为室性心动过速(VT),占71%,18例为室上性心动过速(SVT),占29%.SVT中,8例为SVT伴束支传导阻滞,占12.9%,7例为SVT伴室内差异性传导,占11.3%,3例为SVT伴预激综合征旁道前传,占4.8%与射频消融术后诊断比较,用食道导联心电图对WCT发作患者VT和SVT诊断符合率达100%.结论描记食道导联心电图可确诊WCT,由于其具有快捷、简便、准确、无创、安全的特点,可用于血流动力学稳定WCT患者的急诊鉴别诊断,对终止WCT发作,实施射频消融治疗具有指导作用.

Objective To explore the prognostic value of esophageal electrophysiologic study（EPS） in wide QRS complex tachycardia.Methods EPS was performed in 62 patients with wide QRS complex tachycardia.Results Among these 62 cases,44 cases（71%） were diagnosed as ventricular tachycardia（VT）,and 18 cases（29%） were diagnosed as supraventricular tachycardia（SVT）.Among these 18 cases, 8 cases（12.9%） were diagnosed with bundle branch block（BBB）, 7 cases（11.3%） were diagnosed with intra- ventricular aberrancy and 3 cases（4.8%） were diagnosed with preexcitation syndrome with a AVRT.Compared to the results of radiofrequency catheter ablation（RFCA）, the accuracy rate of EPS was 100%.Conclusion EPS is a safe,rapid means to evaluate the mechanism and to stop wide QRS complex tachycardia.EPS also plays an important guidance role in RFCA.