经食管心脏电生理检查在宽QRS波心动过速鉴别诊断中的应用价值

Value of Esophageal Electrophysiological Examination in Differential Diagnosis of Wide QRS Tachycardia

目的研究经食管心脏电生理检查在宽QRS波心动过速鉴别诊断中的应用价值。方法研究所选病例为我院2017年11月~2018年12月收治的71例宽QRS波心动过速患者,均采用Brugada四步法和食管电生理检查。以心内电生理检查结果为标准,对比2种检查结果’结果食管心脏电生理检查对室性心动过速(VT)的诊断准确率为95.65%,Brugada四步法对VT的诊断准确率为78. 26%;食管心脏电生理检查出现2例误诊,经心内电生理检査均为左后分支型VT合并1:1房室逆传。VT与室上性心动过速(SVT)患者基本资料对比中,VT患者心动过速频率明显快于SVT患者(P <0. 05),而其他基本资料对比无统计学的意义(P >0.05)。与Brugada四步法诊断对比,食管心脏电生理检查对于鉴别诊断宽QRS波心动过速的敏感性、阴性预测值更高(P<0.05);且食管心脏电生理检查终止心动过速发作的成功率方面,SVT患者高于VT患者(P<0.05)c结论经食管心脏电生理检查鉴别诊断宽QRS波心动过速更具优势,对于预防恶性心律失常尤为关键。

Objective To study the value of esophageal electrophysiological examination in the differential diagnosis of wide QRS tachycardia. Methods 71 patients with wide QRS tachycardia admitted to our hospital from Nov. 2017 to Dec. 2018 were included in this study. All patients were given four - step Brugada and esophageal electrophysiological examination. Results of the two examinations were compared. Results The accuracy rate of ventricular tachycardia ( VT) was 95. 65% by esophageal electrophysiological examination. The accuracy rate of VT was 78. 26% by Brugada four - step method. 2 cases were misdiagnosed by esophageal electrophysiological examination, who were diagnosed as left posterior branch VT combined with 1 :1 atrioventricular reverse transmission by intracardiac electrophysiological examination. The tachycardia frequency of VT patients was significantly faster than that of SVT patients ( P < 0. 05), while there was no significant difference on the other basic data( P > 0. 05 ). Compared with Brugada four - step diagnosis, esophageal electrophysiological examination had higher sensitivity and negative predictive value for differential diagnosis of wide QRS tachycardia(P < 0. 05). In addition, the success rate of termination of tachycardia by esophageal electrophysiological examination was higher in SVT patients than that in VT patients( P < 0. 05 ). Conclusion Esophageal electrophysiological examination has more advantage in the differential diagnosis of wide QRS tachycardia ,which is particularly important for the prevention of malignant arrhythmias.