Brembilla-Perrot B
Department of Cardiology, Chu of Brabois, Vandoeuvre, France.
Am Heart J. 1991 Jun;121(6 Pt 1):1714-20. doi: 10.1016/0002-8703(91)90017-c.
Paroxysmal supraventricular tachycardia (SVT) is a benign form of tachycardia that generally does not require costly evaluation. The purpose of this study was to describe a new sign permitting delineation of the mechanism of SVT by analysis of the P wave in lead V1 and the left atrial electrogram, which may be registered by the esophageal electrode. Among 146 patients with SVT, 72 had a ventriculoatrial interval greater than 70 msec. The P wave in lead V1 during SVT was discernible in 69 of them. The precession of the left atrial electrogram on the P wave in lead V1 was always associated with reentry through a left lateral (n = 37) or posteroseptal (n = 4) accessory atrioventricular (AV) connection. When the P wave in lead V1 preceded or occurred simultaneously with the left atrial electrogram, reentry was through either the AV node or a right-sided accessory AV connection. On the other hand, although the P wave in lead V1 was more frequently negative in reentry through a right-sided connection and positive in reentry through a left-sided connection, the polarity was not specific enough to identify the reentry. The precession of the left atrial electrogram recorded by the esophageal electrode on the P wave in lead V1 during SVT was a specific criterion of reentry through a left accessory AV connection, and this technique could be useful for preliminary localization of the accessory connection before electrophysiologic study.
阵发性室上性心动过速（SVT）是一种良性心动过速形式，通常不需要进行昂贵的评估。本研究的目的是描述一种新的体征，通过分析V1导联的P波和左心房电图（可由食管电极记录）来明确SVT的机制。在146例SVT患者中，72例的室房间期大于70毫秒。其中69例在SVT发作时V1导联的P波清晰可见。左心房电图在V1导联P波上的提前出现总是与经左侧（n = 37）或后间隔（n = 4）房室旁道的折返相关。当V1导联的P波先于或与左心房电图同时出现时，折返是通过房室结或右侧房室旁道。另一方面，尽管V1导联的P波在经右侧旁道折返时更常为负向，而在经左侧旁道折返时更常为正向，但这种极性不足以特异性地识别折返。食管电极记录的左心房电图在SVT发作时V1导联P波上的提前出现是经左侧房室旁道折返的特异性标准，该技术在电生理研究前对旁道的初步定位可能有用。
