心室融合波伴心房激动提前对间隔旁路逆传的房室折返性心动过速的诊断作用

Diagnostic implication of ventricular fusion beat with advanced atrial activation for orthodromic atrioventricular reentrant tachycardia using a septal accessory pathway

目的 观察心室融合波伴心房激动提前对间隔旁路逆传的顺向型房室折返性心动过速(OAVRT)的诊断作用。方法 按心内电生理检查标准和射频消融结果 ,将 47例符合入选条件的患者分为两组 :房室结折返性心动过速 (AVNRT)组和间隔旁路逆传的OAVRT组 ,分别为 2 4例和 2 3例。心动过速时行心室期前程序刺激 (RS2 刺激 )和心室快速刺激 ,测量体表心电图上心室融合波之后的心房激动时间是否提前。结果 RS2 刺激和心室快速刺激均能形成多个心室融合波。AVNRT组无 1例伴有心房激动提前 (特异性 10 0 % ) ,而OAVRT组在心室刺激成分明显的心室融合波时 ,心房激动均被提前 (敏感性 10 0 % )。两组间的差异十分显著 (P <0 0 0 1)。结论 心室融合波伴心房激动时间提前是诊断间隔旁路逆传OAVRT的可靠指标 ,具有敏感性和特异性高的特点 ,而且也可用于未能记录到希氏束电图的患者。

Objective The purpose of this study was to observe whether the ventricular fusion beat with advanvced atrial activation is useful for differentiating orthodromic atrioventricular reentrant tachycardia (OAVRT) using a septal accessory pathway from atrioventricular nodal reentrant tachycardia (AVNRT).Methods As determined by the results of electrophysiology study and radiofrequency catheter ablation, 47 consecutive patients with narrow QRS tachycardia that met the inclusion criteria were divided into two groups, 24 patients in AVNRT group and 23 patients with a septal accessory pathway in OAVRT group. Programmed right ventricular stimulation and rapid ventricular pacing were delivered during tachycardia. The atrial activation time was measured if ventricular fusion beat occured on the ECG leads. Results Multiple ventricular fusion beats were observed during ventricular stimulation in all patients of both groups. However, the ventricular fusions beat with advanced atrial activation were demonstrated in none of 24 patients with AVNRT (specificity 100%) and in all 23 patients with OAVRT (sensitivity 100%). The difference between two groups was significant (P<0.001). Conclusion The ventricular fusion beat with advanced atrial activation is a reliable criterion to diagnosis of OAVRT using a septal accessory pathway, with high specificity and sensitivity. It also can be used in patients whose His electrogram is difficult to record.