体表心电图V1和aVL/aVR导联对房室结折返性心动过速的诊断价值

Value of combining V1 and aVL or aVR lead in differential diagnosis of atrioventricular nodal reentrant tachycardia

目的探讨体表心电图V1联合aVL或aVR导联对房室结折返性心动过速(AVNRT)的诊断价值。方法143例窄QRS心动过速患者的体表心电图,含窦性心律和心动过速心电图。由两位未知心动过速类型的心电生理医师进行诊断,记录包括V1导联假r′波、aVL导联末端切迹、心动过速RP′间期≥100ms等指标,心动过速类型由心内电生理检查确定。结果 AVNRT患者年龄较大(P<0.01),女性较多(72.4%vs 50.0%,P<0.01)。aVL导联末端切迹对于诊断AVNRT具有较高敏感度(60.9%)和特异度(89.3%),高于传统V1导联假r′和下壁导联假s波(P均小于0.05);联合V1导联假r′和aVL导联末端切迹或aVR导联假r′波明显提高AVNRT诊断敏感度至78.2%和74.7%,而阳性预测值无明显降低。RP′间期≥100 ms诊断顺向型房室折返性心动过速(AVRT)具有较高敏感度和特异度(敏感度69.6%,特异度87.4%),联合aVR导联ST段J点后80ms下斜型抬高超过1.5mV指标,明显提高AVRT诊断敏感度(89.2%)。结论体表心电图V1和aVL或aVR导联可提高AVNRT诊断价值。

Objective To evaluate the diagnostic accuracy of the combining V1 and aVL or aVR lead in electrocardiographic（ECG） differentiation of atrioventricular nodal reentrant tachycardia（AVNRT） from atrioventricular reciprocating tachycardia（AVRT）.Methods A 12-lead ECG was recorded in 143 consecutive patients with regular paroxysmal supraventricular tachycardia（PSVT）during both sinus rhythm and tachycardia.All ECGs were reviewed by two experienced electrophysiologists who had no knowledge of the tachycardia mechanism.The ECG recordings were evaluated for standard criteria including pseudo-r′-wave in lead V1,notch in lead aVL,pseudo-r′-wave in lead aVR,RP interval≥100ms,ST-segment elevation≥1.5mm at the J-point lasting 80 ms in lead aVR during tachycardia,and so on.Mechanism of arrhythmia was confirmed by the electrophysiological study.Results Patients with AVNRT were older（P 0.01）,predominantly female（72.4% vs 50.0%,P 0.01）.Among the ECG criteria of the AVRT diagnosis,visible P-wave with RP interval≥100 ms had the highest diagnostic accuracy（sensitivity69.6%,specificity 87.4%,and positive predictive value 78.0%）.The combination of visible P-wave with RP interval≥100 ms and ST-segment elevation≥1.5 mm at the J-point lasting 80 ms in lead aVR obviously improved the sensitivity of the AVRT diagnosis.For AVNRT diagnosis,notch in lead aVL had a higher sensitivity（60.9%）,specificity（89.3%）,and positive predictive value（89.8%）compared with the conventional criteria of the pseudo-r′in V1 and pseudo-s in inferior leads（all P 0.05）.The combination of V1 and aVL or aVR lead obviously improved the sensitivity of the AVNRT diagnosis to 78.2% and 74.7%,respectively.But the positive predictive value did not decrease obviously.Conclusion The combination of V1 and aVL or aVR lead is helpful to improve the accuracy of AVNRT diagnosis in ECG.