Simoncelli U, Marchetti A, Sorgato A, Rusconi C
Divisione di Cardiologia, Ospedale S. Orsola Fatebenefratelli, Brescia.
Minerva Cardioangiol. 1991 Jun;39(6):219-25.
Twenty-three consecutive subjects (age 46.7 +/- 21, range 13-78) addressed to our attention for symptoms attributed to documented or suspected supra ventricular arrhythmias underwent transesophageal electrophysiologic study. On the basis of the preliminary investigations 15 proved free from organic heart disease, 2 were affected with ischemic heart disease (secondary angina), 6 with hypertensive cardiomyopathy. In each patient the sensibility, specificity and positive predictive value of the following reports regarding the occurrence of paroxysmal fibrillation and flutter (Ffap) were evaluated: a) echo reports of left atrial enlargement; b) ECG signs of atrial enlargement; c) interatrial conduction time (TCIA) assessed with unipolar transesophageal recording. As TCIA we adopted the time interval intercurrent from the first low-voltage deflection of the esophageal P wave (far field) and the apex of the intrinsecoid deflection of the same wave. TCIA proved significantly longer in the 12 patients affected with Ffap compared with those free from documented paroxysmal or inducible arrhythmias or affected with paroxysmal junctional reciprocating tachycardias: 76.6 +/- 11 vs 51.8 +/- 11.7; p less than 0.001. A TCIA greater than 63 msec characterizes with satisfactory sensibility and specificity the occurrence of Ffap: sens. 75%, spec. 91%, positive predictive value 90%. Echo and ECG reports of atrial enlargement behave as highly specific but not sufficiently sensitive indexes of the occurrence of Ffap: sens. 42%, spec. 100%, pos. pred. val. 100% and sens. 17%, spec. 100%, pos.pred.val. 100% resp. We concluded that TCIA is an index correlated with and predictive of the occurrence of Ffap in patients symptomatic for cardiopalmus or neurologic symptoms in the absence of other arrhythmias detectable with Holter monitoring which are able to produce clinical symptoms.
23名连续的受试者（年龄46.7±21岁，范围13 - 78岁）因记录在案的或疑似室上性心律失常的症状引起我们的关注，接受了经食管电生理研究。根据初步调查，15名被证明无器质性心脏病，2名患有缺血性心脏病（继发性心绞痛），6名患有高血压性心肌病。对每名患者评估了以下关于阵发性颤动和扑动（Ffap）发生情况报告的敏感性、特异性和阳性预测值：a）左心房扩大的超声心动图报告；b）心房扩大的心电图征象；c）用单极经食管记录评估的心房间传导时间（TCIA）。作为TCIA，我们采用食管P波（远场）的第一个低电压偏转与同一波的固有偏转顶点之间的时间间隔。与无记录在案的阵发性或可诱发心律失常或患有阵发性交界性折返性心动过速的患者相比，12名患有Ffap的患者的TCIA明显更长：76.6±11对51.8±11.7；p<0.001。TCIA大于63毫秒以令人满意的敏感性和特异性表征Ffap的发生：敏感性75%，特异性91%，阳性预测值90%。心房扩大的超声心动图和心电图报告表现为Ffap发生的高度特异性但不够敏感的指标：敏感性分别为42%、特异性100%、阳性预测值100%和敏感性17%、特异性100%、阳性预测值100%。我们得出结论，在没有可通过动态心电图监测检测到的、能够产生临床症状的其他心律失常的情况下，对于有心悸或神经症状的患者，TCIA是与Ffap的发生相关并可预测其发生的指标。
