经食道心房调搏术诊断房室结内双径路的标准

STANDARD OF TRANSESOPHAGEAL ATRIAL PACING TO DIAGNOSE DUAL ATRIOVENTRICULAR NODE PATHWAY

作者采用经食道心房调搏术检测了58例心悸者,分为A组(无曲线中断)和B组(有曲线中断)。结果发现:房室传导非典型性文氏周期在两组间无显著性差异;起搏文氏周期中最大SR间期增长值,两组间有高度显著性差异(P<0.001),此值对房室结内双径路的诊断有高度特异性,为96.88％,阳性预测价值为90.91％,敏感性为71.43％,在较大SR问期变化时测得的最小RS增长值,两组间亦有显著差异(P<0.05),其诊断敏感性为78.57％,诊断特异性和阳性预测价值较高,分别为92.86％和91.67％。作者认为后两项结果可考虑作为诊断DAVNP的补充标准。

In order to assess the diagnostic me-thods of dual atrioventricular node pathway(DAVNP), we performed transesophagealatrial pacing in 58 patients with palpitation.These patients were classified into twogroups, group A comprising 40 patients with-out broken A-V conduction curve duringpacing, compared with group B of 18 pa-tients with broken A-V conduction curve. Inour study, both atypical Wenckebach cycleand 3:2 A-V conduction during the incre-ment atrial pacing (IAP) had no significantdifference between the two groups(P>0.05).The maximum increments of SR intervalin Wenckebach cycle of group A and Bduring pacing (Wenckebach Δ SRmax) were83.59±20.92 ms and 125.00±32.52 ms res-pectively (P<0.001)and at the cut-off pointof Wenckebach ΔSRmax at 120 ms thespecificity and positive predicative valuewere very high (96.88% and 90.91%) , butsensitivity was not so high (71.43%) . Theminimum increments of RS interval (ΔRSmin)in a greater change of SR interval showeda significant difference between the twogroups and the specificity and positive pre-dicative value were also high, but the sensi-tivity was not so high, either (78.57%).Weconclude that the diagnostic value of bothWenckebach ΔSRmax and ΔRSmin, whenthe SR interval is of greater change duringpacing to the DAVNP, is rather significant.As the sensitivity is very low, isolatedatypical Wenckebach phenomenon is not asreliable a diagnostic criterion to the DAVNPas previously supposed.