下壁导联ST段压低/T波倒置对窄QRS波心动过速的鉴别作用(摘要)
作者：姚焰 邓旭 王方正 张奎俊 马坚 华伟 田瑞国 朱克平 鲁志民 孙瑞龙 陈新
单位：北京市，中国医学科学院 中国协和医科大学 心血管病研究所 阜外心血管病医院 临床电生理研究室(100037)
关键词：
目的 目的：窄QRS波心动过速的发生机制和旁路位置的无创性初步判定，可以帮助决定介入性操作的器械和步骤，并可减少放射暴露时间，因此，对于临床介入性治疗具有相当的指导意义。为鉴别窄QRS波心动过速，我们观察了心动过速时下壁导联ST段下移/T波倒置与心动过速类型之间的关系。
方法：所有205例体表心电图显示为窄QRS波心动过速的患者(男112例)，窦性心律时体表心电图均无预激综合征存在。全部患者均接受心内电生理检查和射频消融术。观察并测量全部窄QRS波心动过速发作时Ⅱ、Ⅲ和aVF导联ST段压低/T波倒置的幅度。
, 百拇医药
结果：所有患者均由心内电生理检查证实为顺向型房室折返性心动过速(Orthodromic AVRT)(106例)或房室结折返性心动过速(AVNRT)(99例)。在106例AVRT患者中，Ⅱ、Ⅲ、aVF导联T波倒置的敏感度分别为62.5%、70.2%、64.4%,平均压低/倒置幅度分别为1.7±0.8 mV、1.6±0.8 mV和1.5±0.8 mV,而98例AVNRT者Ⅱ、Ⅲ、aVF导联出现类似ST-T波改变的比例分别为：6.7%、16.3%和6.7%(P<0.001)。对于由隐匿性旁路参与的窄QRS波的AVRT，Ⅱ、Ⅲ、aVF导联出现T波倒置的特异度分别为93%、90%和93%。右侧旁路参与的AVRT，Ⅱ、Ⅲ和aVF导联发生ST段压低/T波倒置的比例分别为84%、86%和84%，明显高于左侧旁路AVRT(48%、53%及50%，P<0.001)。
结论：窄QRS波的心动过速时出现下壁导联(Ⅱ、Ⅲ、aVF)ST段压低或/和T波倒置>1.5 mV时，高度提示为顺向型AVRT。这有助于及时识别窄QRS波心动过速AVRT，尤其是右侧隐匿性旁路参与的AVRT。
, 百拇医药
Diagnostic Value of ST Segment Depression /T Wave Inversion on Inferior Leads during Narrow QRS Complex Supraventricular Tachycardia (Abstract)
Department of Clinical Electrophysiology, Cardiovascular Institute and Fu Wai Hospital, CAMS and PUMC, Beijing (100037)
Yao Yan, Deng Xu, Wang Fangzheng, et al.
Objective: To explore the diagnostic value of ST segment depression T wave inversion on inferior leads during narrow QRS complex tachycardia.
, http://www.100md.com
Methods: We analyzed 12-lead electrocardiograms of 205 patients (112 males) during narrow QRS complex supraventricular tachycardia to evaluate the significance of ST segment depression/T wave inversion. All patients underwent complete electrophysiologic evaluation and successful radiofrequency catheter ablation. None of them had pre-excitation in sinus rhythm.
Results: There were 99 atrioventricular node reentrant tachycardias (AVNRT) and 116 AV reciprocating tachycardias (AVRT). ST segment depression or T wave inversion >1.5 mV on inferior lead was present more often in AVRT than in AVNRT, and the sensitivity were 62.5% vs. 6.7%, 70.2% vs. 16.3% and 64.4% vs. 6.7% on lead Ⅱ, Ⅲ and aVF, respectively. The mean magnitude of T inversion of AVRT on lead Ⅱ, Ⅲ and aVF 1.7±0.8 mV, 1.6±0.8 mV and 1.5±0.8 mV. For AVRT, the specificity of ST depression/T wave inversion were 93%, 90% and 93% on lead Ⅱ, Ⅲ and aVF. The percentages of ST segment/T wave inversion on lead Ⅱ, Ⅲ and aVF in AVRT with right side accessory pathway were significantly higher than those with left side accessory pathway (84% vs. 48%, 86% vs. 53% and 82% vs. 50%, respectively, all p<0.001).
Conclusion: The presence of ST segment depression/T wave inversion >1.5 mV on inferior leads during narrow QRS complex tachycardia, strongly suggests arioventricular reciprocating tachycardia. This finding is helpful for the promptly distinguisgment of orthodromic AVRT using a concealed accessory pathway., 百拇医药
单位：北京市，中国医学科学院 中国协和医科大学 心血管病研究所 阜外心血管病医院 临床电生理研究室(100037)
关键词：
目的 目的：窄QRS波心动过速的发生机制和旁路位置的无创性初步判定，可以帮助决定介入性操作的器械和步骤，并可减少放射暴露时间，因此，对于临床介入性治疗具有相当的指导意义。为鉴别窄QRS波心动过速，我们观察了心动过速时下壁导联ST段下移/T波倒置与心动过速类型之间的关系。
方法：所有205例体表心电图显示为窄QRS波心动过速的患者(男112例)，窦性心律时体表心电图均无预激综合征存在。全部患者均接受心内电生理检查和射频消融术。观察并测量全部窄QRS波心动过速发作时Ⅱ、Ⅲ和aVF导联ST段压低/T波倒置的幅度。
, 百拇医药
结果：所有患者均由心内电生理检查证实为顺向型房室折返性心动过速(Orthodromic AVRT)(106例)或房室结折返性心动过速(AVNRT)(99例)。在106例AVRT患者中，Ⅱ、Ⅲ、aVF导联T波倒置的敏感度分别为62.5%、70.2%、64.4%,平均压低/倒置幅度分别为1.7±0.8 mV、1.6±0.8 mV和1.5±0.8 mV,而98例AVNRT者Ⅱ、Ⅲ、aVF导联出现类似ST-T波改变的比例分别为：6.7%、16.3%和6.7%(P<0.001)。对于由隐匿性旁路参与的窄QRS波的AVRT，Ⅱ、Ⅲ、aVF导联出现T波倒置的特异度分别为93%、90%和93%。右侧旁路参与的AVRT，Ⅱ、Ⅲ和aVF导联发生ST段压低/T波倒置的比例分别为84%、86%和84%，明显高于左侧旁路AVRT(48%、53%及50%，P<0.001)。
结论：窄QRS波的心动过速时出现下壁导联(Ⅱ、Ⅲ、aVF)ST段压低或/和T波倒置>1.5 mV时，高度提示为顺向型AVRT。这有助于及时识别窄QRS波心动过速AVRT，尤其是右侧隐匿性旁路参与的AVRT。
, 百拇医药
Diagnostic Value of ST Segment Depression /T Wave Inversion on Inferior Leads during Narrow QRS Complex Supraventricular Tachycardia (Abstract)
Department of Clinical Electrophysiology, Cardiovascular Institute and Fu Wai Hospital, CAMS and PUMC, Beijing (100037)
Yao Yan, Deng Xu, Wang Fangzheng, et al.
Objective: To explore the diagnostic value of ST segment depression T wave inversion on inferior leads during narrow QRS complex tachycardia.
, http://www.100md.com
Methods: We analyzed 12-lead electrocardiograms of 205 patients (112 males) during narrow QRS complex supraventricular tachycardia to evaluate the significance of ST segment depression/T wave inversion. All patients underwent complete electrophysiologic evaluation and successful radiofrequency catheter ablation. None of them had pre-excitation in sinus rhythm.
Results: There were 99 atrioventricular node reentrant tachycardias (AVNRT) and 116 AV reciprocating tachycardias (AVRT). ST segment depression or T wave inversion >1.5 mV on inferior lead was present more often in AVRT than in AVNRT, and the sensitivity were 62.5% vs. 6.7%, 70.2% vs. 16.3% and 64.4% vs. 6.7% on lead Ⅱ, Ⅲ and aVF, respectively. The mean magnitude of T inversion of AVRT on lead Ⅱ, Ⅲ and aVF 1.7±0.8 mV, 1.6±0.8 mV and 1.5±0.8 mV. For AVRT, the specificity of ST depression/T wave inversion were 93%, 90% and 93% on lead Ⅱ, Ⅲ and aVF. The percentages of ST segment/T wave inversion on lead Ⅱ, Ⅲ and aVF in AVRT with right side accessory pathway were significantly higher than those with left side accessory pathway (84% vs. 48%, 86% vs. 53% and 82% vs. 50%, respectively, all p<0.001).
Conclusion: The presence of ST segment depression/T wave inversion >1.5 mV on inferior leads during narrow QRS complex tachycardia, strongly suggests arioventricular reciprocating tachycardia. This finding is helpful for the promptly distinguisgment of orthodromic AVRT using a concealed accessory pathway., 百拇医药