通过逆行P波振幅鉴别房室结折返性心动过速慢-慢型与经后间隔旁路的房室折返性心动过速

Differentiation of Slow-Slow Form of AVNRT from AVRT through a Posteroseptal Accessory Pathway by Retrograde P-Wave Amplitude.

作者信息

Nakatani Yosuke, Mizumaki Koichi, Sakamoto Tamotsu, Kataoka Naoya, Nishida Kunihiro, Yamaguchi Yoshiaki, Tsujino Yasushi, Inoue Hiroshi

机构信息

Second Department of Internal Medicine, University of Toyama, Toyama, Japan.

Clinical Research and Ethics Center, University of Toyama, Toyama, Japan.

出版信息

Pacing Clin Electrophysiol. 2016 Mar;39(3):241-9. doi: 10.1111/pace.12794. Epub 2016 Jan 12.

DOI:10.1111/pace.12794

PMID:26643980

Abstract

BACKGROUND

This study aimed to clarify whether retrograde P-wave amplitude during tachycardia can be used to differentiate slow-slow form of atrioventricular nodal reentrant tachycardia (S/S-AVNRT) from atrioventricular reentrant tachycardia through a posteroseptal accessory pathway (PS-AVRT).

METHODS

Sixteen patients with S/S-AVNRT and 14 patients with PS-AVRT constituted the study group. Electrocardiographic and electrophysiological parameters were compared between both the groups. HA(CS-His), which indicates the location of the earliest atrial activation site during tachycardia, was calculated as the difference of the shortest HA interval in the His bundle region and the coronary sinus region.

RESULTS

Negative deflection of the retrograde P wave during tachycardia was significantly greater in S/S-AVNRT than in PS-AVRT in the inferior leads (lead aVF, -0.22 ± 0.04 mV vs -0.10 ± 0.07 mV; P < 0.001). Among the electrocardiographic parameters, retrograde P-wave amplitude in lead aVF had the highest diagnostic accuracy (area under the curve 0.975, sensitivity 93%, and specificity 88% for a cutoff value of -0.16 mV). HA(CS-His) was negatively greater in S/S-AVNRT than in PS-AVRT (-24 ± 13 ms vs -3 ± 18 ms; P = 0.001), and was significantly correlated with the retrograde P-wave amplitude in lead aVF (P = 0.004).

CONCLUSION

Deeper negative deflection of the retrograde P wave in the inferior lead can help differentiate S/S-AVNRT from PS-AVRT.

摘要

背景

本研究旨在明确心动过速时逆行P波振幅是否可用于区分房室结折返性心动过速的慢-慢型（S/S-AVNRT）与经后间隔旁路（PS-AVRT）的房室折返性心动过速。

方法

16例S/S-AVNRT患者和14例PS-AVRT患者构成研究组。比较两组的心电图和电生理参数。HA（CS-His）表示心动过速时最早心房激动部位的位置，计算方法为希氏束区域和冠状窦区域最短HA间期的差值。

结果

S/S-AVNRT患者心动过速时在下壁导联（aVF导联）逆行P波的负向偏转显著大于PS-AVRT患者（-0.22±0.04 mV对-0.10±0.07 mV；P<0.001）。在心电图参数中，aVF导联的逆行P波振幅诊断准确性最高（曲线下面积为0.975，截断值为-0.16 mV时，敏感性为93%，特异性为88%）。S/S-AVNRT患者的HA（CS-His）负值大于PS-AVRT患者（-24±13 ms对-3±18 ms；P = 0.001），且与aVF导联的逆行P波振幅显著相关（P = 0.004）。