长RP心动过速的动态心电图研究

Research on ambulatory electrocardiography of long RP tachycardia

目的探讨长RP心动过速的动态心电图表现及其鉴别诊断依据。方法采用12通道动态心电图记录仪对35例长RP心动过速患者进行监测,对心动过速发作时的诱发及终止状态、持续时间、频率,P波极性及临床特点等方面进行对比分析。结果持续性房室折返性心动过速(PAVRT)、房性心动过速(AT)及快-慢型房室结折返性心动过速(F-S-AVNRT)三组患者中,心动过速发生时P波于Ⅱ、Ⅲ、a VF导联倒置,a VR导联直立,RP间期均>PR间期。6例PAVRT发作时均呈无休止状态,心动过速发作占24 h总心跳的32.8%~50.0%,由室早诱发,发作时频率110~160次/min。15例房速均由房早诱发,发作阵数在1~186阵,发作时频率107~150次/min;两例F-S-AVNRT由房早伴PR间期延长所诱发,发作时频率127~182次/min。12例房扑伴2∶1房室传导由房早诱发,发作时心室率120~165次/min,符合Bix定律时心室率150次/min。结论动态心电图监测对长RP心动过速发作时的诱发及终止状态、持续时间、频率等有鉴别诊断意义,有助于诊断长RP心动过速。

Objective To study the manifestations of long RP tachycardia on ambulatory electrocardiography( AECG) and its differential diagnostic basis. Methods By 12-channel AECG recorder,35 patients with long RP tachycardia were monitored. At the attack of tachycardia,we made comparative analysis on its states of induction and termination,duration,frequency,P-wave polarity,clinical characteristics,etc. Results The enrolled 35 patients were divided into 3 groups: separately with persistent atrioventricular reentrant tachycardia( PAVRT),atrial tachycardia( AT),and fast-slow atrioventricular nodal reentrant tachycardia( F-S-AVNRT). Among the 3 groups,P waves were inverted in Ⅱ,Ⅲ and a VF leads,a VR leads were upright,and RP intervals were all longer than PR intervals,at the onset of tachycardia. The attack of 6 cases of PAVRT was endless,tachycardia accounting for32. 8% —50. 0% in the total heartbeats during 24 hours,with an attacking frequency ranging from 110 times / min to 160 times / min,which was induced by premature ventricular beats. AT was induced by atrial premature beats in 15 cases,with the number of onset episodes ranging from 1 to 186,and onset frequency 107—150 times / min. F-S-AVNRT in 2 cases was induced by atrial premature beats accompanied with prolonged PR intervals,with an attack frequency ranging from 127 times / min to 182 times / min. Atrial flutter complicating 2 ∶ 1 atrioventricular conduction in 12 cases was induced by at-rial premature beats; Its onset ventricular rate ranged from 120 times / min to 165 times / min,and the ventricular rate reached 150 times / min when the conditions of the Bix law was met. Conclusion AECG monitoring plays a significant role in identifying the states of induction and termination,duration,and frequency during the onset of long RP tachycardia. It helps to diagnose the disease.