Haaland Hilde Hellebust, Morstøl Torstein Holm, Vegsundvåg Johnny, Hole Torstein
Kardiologisk seksjon, Medisinsk avdeling, Alesund sjukehus.
Tidsskr Nor Laegeforen. 2003 Sep 25;123(18):2577-9.
We wanted to evaluate transoesophageal atrial stimulation as a diagnostic tool in the evaluation of paroxysmal supraventricular tachycardias.
185 procedures in 177 patients were evaluated retrospectively. The main reasons for referral to transoesophageal atrial stimulation were documented (52%) or suspected (43%) paroxysmal supraventricular tachycardias. The procedure consisted of incremental atrial stimulation to second degree A-V block, adding up to three extra stimuli, repeating the protocol with isoprenalin 2 and 5 mg/min and completing the procedure with rapid atrial stimulation 300-800/min. Induced tachycardias were classified according to the R-P interval.
The procedure was well tolerated. Supraventricular tachycardias were induced in 72/96 (75%) of patients with documented paroxysmal supraventricular tachycardias and in 41/80 (51%) of patients with suspected paroxysmal supraventricular tachycardias. Out of the 101 patients (55%) who were referred for invasive electrophysiological study, 79 (78%) had an inducible supraventricular tachycardia at transoesophageal stimulation. When stimulation resulted in a tachycardia with measurable R-P interval, the accuracy of our diagnosis was 87%.
Transesophageal atrial stimulation has proved to be a useful diagnostic tool in the management of paroxysmal supraventricular tachycardias at our hospital. Nearly half the patients required no further investigations after transoesophageal atrial stimulation.
我们希望评估经食管心房刺激作为阵发性室上性心动过速评估中的一种诊断工具。
对177例患者的185项操作进行回顾性评估。转诊接受经食管心房刺激的主要原因包括已记录（52%）或疑似（43%）阵发性室上性心动过速。该操作包括递增心房刺激至二度房室阻滞，最多增加三个额外刺激，使用2和5mg/min的异丙肾上腺素重复该方案，并以300 - 800次/分钟的快速心房刺激完成操作。诱发的心动过速根据R - P间期进行分类。
该操作耐受性良好。在有记录的阵发性室上性心动过速患者中，72/96（75%）诱发了室上性心动过速；在疑似阵发性室上性心动过速患者中，41/80（51%）诱发了室上性心动过速。在转诊进行有创电生理研究的101例患者（55%）中，79例（78%）在经食管刺激时可诱发室上性心动过速。当刺激导致可测量R - P间期的心动过速时，我们诊断的准确性为87%。
在我们医院，经食管心房刺激已被证明是阵发性室上性心动过速管理中的一种有用诊断工具。近一半患者在经食管心房刺激后无需进一步检查。
