心电图aVL导联对阵发性室上性心动过速折返途径的鉴别作用
目前射频消融治疗已经成为阵发性室上性心动过速（ＰＳＶＴ）的首选治疗方法，在射频消融治疗前判断心动过速类型有利于手术的准备和进行。体表心电图有助于ＰｓＶＴ的鉴别诊断。标准心电图算法（Ｖ。导联伪Ｒ及下壁导联伪Ｓ波）及近年来提出的新算法已经用于房室结折返性心动过速（ＡＶＮＲＴ）和房室折返性心动过速（ＡＶＲＴ）的鉴别，但是单纯ａＶＬ导联对ＡＶＮＲＴ和ＡＶＲＴ的鉴别作用还未得到证实。本研究的目的在于探讨体表心电图单纯ａＶＬ导联对ＡＶＮＲＴ和ＡＶＲＴ的鉴别作用。Ｖ，导联ＱＲＳ波终末部正向波折，类似不完全性右束支阻滞，窦性节律时不存在；下壁导联伪ｓ波：心动过速时下壁导联ＱＲＳ波终末部负向波折，窦性节律时不存在。ａＶＬ导联切迹：心动过速时ａＶＬ导联终末部正向的波折，窦性节律时不存在；ａＶＲ导联ｓＴ段抬高：心动过速时ａＶＲ导联ＳＴ段水平型或上斜型抬高≥１．０ｍｍ，持续时间≥８０ｍｓ，下斜型抬高≥１．５ｎｌｉｎ，持续时间１＞８０ｉｎｓ，窦性心律时不存在；ＱＲＳ电交替：心动过速时至少一个导联上出现ＱＲｓ波幅震荡≥１ｍｍ。（图ｌ一３）
１资料与方法
病例选择：选取２００９—０１至２００９－１ｌ因症状性ＰＳＶＴ
在我院行心脏射频消融术（ＲＦＣＡ）治疗的连续病例１１２
例，按心动过速类型分为ＡＶＮＲＴ者（，ｌ＝６０）和ＡＶＲＴ
者（ｎ＝５２）。排除标准：①房性心动过速；②显性预激综
合征；③窦性心律时存在束支传导阻滞；④经电生理检
查不能明确心动过速类型。
分析方法和分析指标：分别记录窦性心律及心动过
速时的体表１２导联心电图，记录标准为纸速２５ｍｍ／８，
振幅１０ｍｍ／ｍＶ，滤波频率－００Ｈｚ＾．全ＶＮＲＴ和ＡＶＲＴ．。ｍ”ｌ。宝嚣萎妻黜量嚣等墨翥鬈嚣翟嚣的标准心电图算法定义如下：Ｖ１导联伪Ｒ：心动过速时挫１Ｅ、ＩＦ：心动过速时ＱＲＳ终末，波‘
图２、３患者心电图２Ａ、２Ｂ：ａＶＬ切迹合并Ｖｌ导联伪Ｒ波的房室结折返性心动过速１例３Ａ、３Ｂ：ａＶＬ导联切迹不合并Ｖｌ导联伪Ｒ波及下壁导联伪Ｓ波的房室结折返性心动过速ｌ例
统计学处理：采用ＳＰｓＳｌ６．０统计软件完成，计量资料采用均数±标准差（ｉ±ｓ），样本均数的比较用ｔ检验，样本阳性率的比较用ｒ检验，以Ｐ＜ｏ．０５为差异有统计学意义。
２结果
１１２例人选病例中，ＡＶＮＲＴ６０例（５３．６％）和ＡＶＲＴ５２例（４６．４％），两者在年龄上差异无统计学意义（Ｐ＞０．０５），ＡＶＮＲＴ者与ＡＶＲＴ者比较女性的比例高（５５．６％和３３．３％），心电图统计特点：ａＶＬ切迹发生比例大（５３．３％和１７．９％），Ｖ。导联伪Ｒ波发生比例大（４６．７％和１５．４％），下壁导联伪ｓ波发生比例大
（４２．２％和５．１％），差异均有统计学意义（Ｐ均＜Ｏ．０５—０．０１）。ａＶＲ导联ｓＴ段抬高发生在ＡＶＮＲＴ的比例（３７．１％）低于ＡＶＲＴ（７１．８％）（Ｐ＝０．００１），差异有统计学意义。ａＶＲ导联ｓＴ段抬高的ＡＶＲＴ患者中７１．４％为左侧旁路。ＱＲＳ电交替两者差异无统计学意义（Ｐ＞０．０５）。（表Ｉ）ａＶＬ切迹和Ｖ。导联伪Ｒ波及下壁导联伪Ｓ波诊断ＡＶＮＲＴ的敏感性分别为５３．３％、４６．７％，４２．２％，特异性分别是８２．１％、８４．６％、９４．９％。ａＶＬ切迹诊断ＡＶＮＲＴ的敏感性高于Ｖ，导联伪Ｒ波及下壁导联伪Ｓ波（标准心电图算法），但是三者之间差异没有统计学意义（Ｐ＞０．０５），特异性三者
之间亦无统计学意义（Ｐ＞０．０５）。
心电图aVL导联对阵发性室上性心动过速折返途径的鉴别作用
作者：王蒙， 陈良华， 宋尚明， 刘同宝， WANG Meng， CHEN Liang-hua， SONG Shang-ming ， LIU Tong-bao
作者单位：山东大学附属省立医院,心内科,山东省济南市,250021
刊名：
中国循环杂志
英文刊名：CHINESE CIRCULATION JOURNAL
年，卷(期)：2010,25(5)
参考文献(22条)
1.Arya A;Dorszewski A;Gerds-Li JH Differentiating atrioventricular nodal reentrant tachycardia from tachycardia via concealed accessory pathway[外文期刊] 2005(07)
2.Kalbfleisch SJ.EI-Atassi R.Calkins H Differentiation of paroxysmal narrow QRS complex tachycardias using the 12-lead electrocardiogram 1993(1)
3.Jaeggi ET;Gilljam T;Bauersfeld U Electrocardiographic differentiation of typical atrioventricular node reentrant tachycardia from atrioventricular reciprocating tachycardia mediated by concealed accessory pathway in children[外文期刊] 2003(09)
4.Jaeggi ET.Gilljam T.Bauersfeld U Electrocardiographic differentiation of typical atrioventricular node reentrant tachycardia from atrioventricular reciprocating tachycardia mediated by concealed accessory pathway in children 2003(9)
5.Kalbfleisch SJ;EI-Atassi R;Calkins H Differentiation of paroxysmal narrow QRS complex tachycardias using the 12-lead electrocardiogram 1993(01)
6.Arya A.Dorszewski A.Gerds-Li JH Differentiating atrioventricular nodal reentrant tachycardia from tachycardia via concealed accessory pathway 2005(7)
7.Di Toro D;Hadid C;Luis V Utility of the aVL lead in the electrocardiographic diagnosis of atrioventricular node re-entrant tachycardia 2009(07)
8.Kilic A.Amasyali B.Kose S Atrioventricular nodal reentrant tachycardia ablated from left atrial septum:clinical and electrophysiological characteristics and long-term follow-up results as compared to conventional right-sided ablation 2005(6)
9.González-Torrecilla E;Almendral;Arenal A Independent predictive accuracy of classical electrocardiographic criteria in the diagnosis of paroxysmal atrioventricular reciprocating tachycardias in patients without pre-excitation 2008(05)
10.Sorbera C.Cohen M.Woolf P Atrioventricular nodal reentry tachycardia:slow pathway ablation using the transseptal approach 2000(9)
11.Ho YL;Lin LY;Lin JL Usefulness of ST-segment elevation in lead aVR during tachycardia for determining the mechanism of narrow QRS complex tachycardia[外文期刊] 2003(12)
12.Wu J.Olgin https://www.wendangku.net/doc/0a10696847.html,ler JM Mechanism underlying the reentrant circuit reentrant tachycardia of atrioventricular nodal in isolated canine atrioventricular nodal preparation using optical mapping 2001(11)
13.Anselme F;Papageorgiou P;Monahan K Presence and significance of the left atrionodal connection during atrioventricular nodal reentrant tachycardia[外文期刊] 1999(11)
14.Inoue S.Becker AE Posterior extension of the human compact atrioventricular node:a neglected anatomic feature of potential clinical significance 1998(2)
15.Inoue S;Becker AE Posterior extension of the human compact atrioventricular node:a neglected anatomic feature of potential clinical significance 1998(02)
16.Anselme F.Papageorgiou P.Monahan K Presence and significance of the left atrionodal connection during atrioventricular nodal reentrant tachycardia 1999(11)
17.Wu J;Olgin J;Miller JM Mechanism underlying the reentrant circuit reentrant tachycardia of atrioventricular nodal in isolated canine atrioventricular nodal preparation using optical mapping [外文期刊] 2001(11)
18.Di Toro D.Hadid C.Luis V Utility of the aVL lead in the electrocardiographic diagnosis of atrioventricular node re-entrant tachycardia 2009(7)
19.Sorbera C;Cohen M;Woolf P Atrioventricular nodal reentry tachycardia:slow pathway ablation using the transseptal approach[外文期刊] 2000(09)
20.Ho YL.Lin LY.Lin JL Usefulness of ST-segment elevation in lead aVR during tachycardia for determining the mechanism of narrow QRS complex tachycardia 2003(12)
21.Kilic A;Amasyali B;Kose S Atrioventricular nodal reentrant tachycardia ablated from left atrial septum:clinical and electrophysiological characteristics and long-term follow-up results as compared to conventional right-sided ablation[外文期刊] 2005(06)
22.González-Torrecilla E.Almendral.Arenal A Independent predictive accuracy of classical electrocardiographic criteria in the diagnosis of paroxysmal atrioventricular reciprocating tachycardias in patients without pre-excitation 2008(5)
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