经食管电生理检查室上性心动过速左侧偏心性激动的诊断效能分析

Evaluation of diagnostic value of left eccentric excitation in supraventricular tachycardia by esophageal electrophysiology

目的分析经食管电生理检查阵发性室上性心动过速(PSVT)左侧偏心性激动的诊断效能,提高该类PSVT诊断的准确性。方法本研究为回顾性研究,连续纳入2020年8月至2021年12月就诊于华中科技大学同济医学院附属同济医院且PSVT经食管电生理检查表现为"左侧偏心性激动"的患者,并根据心内电生理检查结果分为房室折返性心动过速(左侧旁路,L-AVRT)组和房室结折返性心动过速(AVNRT)组。比较L-AVRT组和AVNRT组经食管电生理检查的各种间期和P波的极性,评价经食管电生理检查的准确性,同时分析造成经食管电生理检查错误诊断的原因。结果共纳入101例患者,年龄(42.45±14.17)岁,其中男64例(63.3%,64/101)。心内电生理检查结果显示L-AVRT有94例(93%,94/101),AVNRT有7例(7%,7/101)。影响7例AVNRT诊断的主要因素是经食管电生理检查表现为左侧偏心性激动。在AVNRT组中,6例(85.7%,6/7)患者P波在Ⅰ导联呈等电位,在aVL导联呈正向波;在L-AVRT组中,79例(84.0%,79/94)患者P波在Ⅰ导联呈负向波,而全部(94/94)患者P波在aVL导联均无正向波。利用aVL导联的P波极性特征可以提升经食管电生理检查中左侧偏心性激动的敏感度及特异度至95.7%及100.0%。结论PSVT发作时通过经食管电生理检查左侧偏心性激动的表现来判定PSVT的类型存在一定的局限性,需要结合Ⅰ、aVL导联P波的极性综合判定。

Objective To evaluate the diagnostic efficacy of transesophageal electrophysiological examination in the detection of left eccentric excitation of paroxysmal supraventricular tachycardia(PSVT),with the ultimate goal of improving the overall accuracy of diagnosing this type of PSVT.Methods This study was a retrospective study.The patients who were admitted to the Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from August 2020 to December 2021,and had PSVT with esophageal electrophysiological examination showing"left-eccentric excitation"were included.According to the results of intracardiac electrophysiological examination,they were divided into two groups:left-sided bypass atrioventricular reentrant tachycardia(L-AVRT)group and atrioventricular node reentrant tachycardia(AVNRT)group.The various intervals of esophageal electrophysiology and the polarity of P wave were compared between L-AVRT group and AVNRT group to evaluate the accuracy of esophageal electrophysiology examination,and the causes of misdiagnosis were also analyzed.Results A cohort of 101 patients were selected,with(42.45±14.17)years of age,the inclusion of 64 males(63.3%,64/101).It showed that there were 94 cases(94/101,93%)in the L-AVRT group and 7 cases(7/101,7%)in the AVNRT group.In the AVNRT group,7 cases of esophageal electrophysiology revealed left eccentric excitation,which was the primary cause of PSVT misclassification by esophageal electrophysiology examination.In the AVNRT group,6 cases(85.7%,6/7)showed equipotential P waves in lead I and positive P waves in lead aVL.In contrast,in the L-AVRT group,79 patients(84.0%,79/94)patients had negative P waves in lead I,while all patients(94/94)had no positive P waves in lead aVL.The sensitivity and specificity of left eccentric excitation in transesophageal electrophysiological examination could be improved to 95.7% and 100.0% by using the polarity characteristics of P wave in lead aVL.Conclusion There are some limitations in judging the type of PSVT by transesophageal electrophysiological examination of the performance of left eccentric excitation,which needs to be comprehensively judged by combining the polarity of P wave in lead I and aVL.