食管心房调搏在快速型心律失常诊断中的临床意义

吴婷玉; 徐玮; 王本芳

doi:10.13898/j.cnki.issn.1000-2200.2020.12.006

食管心房调搏在快速型心律失常诊断中的临床意义

Clinical significance of transesophageal atrial pacing in the diagnosis of tachyarrhythmia

摘要

摘要:
目的探究食管心房调搏在快速型心律失常诊断中的临床意义。
方法选择85例快速型心律失常病人作为研究对象，实行食管心房调搏检查，测定食管导联的R-P'E、P'E-R时限，比较V1导联的R-P'时限与食管导联的R-P'E时限，并与心脏电生理检查的结果作比较。
结果经心脏电生理确诊后的分型：顺向型房室折返型心动过速（O-AVRT）57例，慢-快型房室结内折返性心动过速AVNRT（S-F）19例，房性心动过速1例，心房扑动1例，心房颤动2例，左心室特发性室速3例，冠状动脉窦无冠窦底起源的AT合并右房间隔部起源的心房扑动1例，左心房AT合并慢-快型房室结内折返性心动过速1例。经食管心房调搏检查发现AVNRT（S-F）型病人食管导联中R-P'E < P'E-R，且R-P'E < 70 ms；O-AVRT型病人大多R-P'E < P'E-R，且R-P'E>70 ms；右侧旁道型病人V1导联的R-P' < 食管导联R-P'E；左侧旁道型病人V1导联的R-P'>食管导联的R-P'E。经食管心房调搏终止，85例病人的快速型心律失常有效终止率为88%。
结论食管心房调搏可以鉴别快速型心律失常的类型，尤其是其中阵发性室上性心动过速的分型，对后续治疗方案的合理制定、心脏电生理检查以及射频消融术均提供了帮助，且对快速型心律失常有较高的终止率。

Abstract:
ObjectiveTo investigate the clinical significance of transesophageal atrial pacing in the diagnosis of tachyarrhythmia.
MethodsEighty-five patients with tachyarrhythmia were selected as the study subjects, and the transesophageal atrial pacing of the esophagus was carried out to determine the time limits of R-P'E and P'E-R of esophageal lead.The time limits between R-P' of V1 lead and R-P'E of esophageal lead were compared, and the results of which was compared with the results of the cardiac electrophysiological examination.
ResultsThe tachycardia in all cases were typed after cardiac electrophysiology diagnosing, and the consequent type atrioventricular turn-back core tachycardia(O-AVRT)in 57 cases, slow-fast in atrioventricular node turn-back tachycardia(AVNRT(S-F) in 19 cases, room tachycardia in 1 case, atrial flutter in 1 case, atrial fibrillation in 2 cases, left ventricular idiopathic ventricular tachycardia(ILVT)in 3 cases, AT without coronary sinus origin combined with atrial flutter of right atrial septum origin in the coronary sinus in 1 case, and left atrial AT combined with slow - fast atrioventricular node reentrant tachycardia in 1 cases were found.The results of transesophageal atrial pacing showed that the R-P'E was less than P'E-R, and the R-P'E was less than 70 ms in esophageal lead of AVNRT(S-F)type patient.The R-P'E was less than P'E-R, and the R-P'E was more than 70 ms in most O-AVRT type patients.The R-P' of lead V1 in right side bypass patients was less than R-P'E of esophageal lead, and the R-P' of V1 lead in left side bypass patients was more than R-P'E of esophageal lead.The effective termination rate of tachyarrhythmia was 88% in 85 patients with transesophageal atrial pacing.
ConclusionsThe transesophageal atrial pacing can distinguish the types of tachyarrhythmia, especially the classification of paroxysmal supraventricular tachycardia, which provides help for the rational formulation of follow-up treatment, cardiac electrophysiological examination and radiofrequency ablation.Moreover, the transesophageal atrial pacing has a higher termination rate for tachyarrhythmia.

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