Twidale N, Roberts-Thomson P, Tonkin A M
Department of Medicine, Flinders Medical Centre, Bedford Park, SA.
Aust N Z J Med. 1989 Feb;19(1):11-5. doi: 10.1111/j.1445-5994.1989.tb01665.x.
The utility of transesophageal electrocardiography using a bipolar 'pill electrode' was assessed in 17 consecutive patients with tachycardia presenting to our casualty department. Standard 12-lead electrocardiography showed regular narrow QRS tachycardia in 12 patients, and five patients had wide QRS tachycardia. Esophageal atrial electrogram recordings were obtained in 14 patients (82%), and these were helpful in determining the mechanism of tachycardia in 11 patients (78%). Of these 11, seven patients fulfilled criteria for atrioventricular junctional (AVJ) tachycardia based on measurement of the minimum interval between the onset of ventricular depolarisation and earliest atrial (esophageal) activity. One of these patients had presented with a wide QRS tachycardia. The other four patients were diagnosed as having ventricular tachycardia (VT) following diagnosis of AV dissociation. Atrial overdrive pacing, via the pill electrode, successfully reverted four of the nine patients (44%) with narrow QRS tachycardia but no patient with VT. Esophageal recording during tachycardia is a simple, relatively non-invasive technique which is helpful in suggesting the mechanism of tachycardia both in patients with narrow and wide QRS tachycardia, and may have a therapeutic role in patients with AVJ tachycardia.
我们对17例因心动过速前来急诊科就诊的患者，评估了使用双极“药丸电极”进行经食管心电图检查的效用。标准12导联心电图显示，12例患者为规则的窄QRS心动过速，5例患者为宽QRS心动过速。14例患者（82%）获得了食管心房电图记录，其中11例患者（78%）的记录有助于确定心动过速的机制。在这11例患者中，7例根据心室去极化开始与最早心房（食管）活动之间的最短间隔测量，符合房室交界性（AVJ）心动过速的标准。其中1例患者表现为宽QRS心动过速。另外4例患者在诊断为房室分离后被诊断为室性心动过速（VT）。通过药丸电极进行心房超速起搏，成功使9例窄QRS心动过速患者中的4例（44%）恢复正常，但对VT患者无效。心动过速期间的食管记录是一种简单、相对无创的技术，有助于提示窄QRS和宽QRS心动过速患者心动过速的机制，并且可能对AVJ心动过速患者具有治疗作用。
