天津医药

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非折返性房性心动过速P波形态的定位诊断

孙建美1,李琼2,卢凤民3,许静2   

  1. 1. 天津医科大学
    2. 天津市胸科医院
    3. 天津市胸科医院心内一科
  • 收稿日期:2011-06-16 修回日期:2011-11-18 出版日期:2012-03-15 发布日期:2012-03-15
  • 通讯作者: 孙建美

P-wave Configuration of the Atrial Tachycardia to Predict the Site Origin

  • Received:2011-06-16 Revised:2011-11-18 Published:2012-03-15 Online:2012-03-15

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摘要： 摘要 目的：对房性心动过速（房速）时心电图P波形态和射频消融靶点对比，以期通过心电图P波特征判定房速起源。方法：对37例成功行单靶点消融治疗的房速病人，对P波形态和参数与消融靶点进行对比分析。计算房速时PR与PP间期比值（PRI）评价激动在房室结传导的时程变化；计算P波与PR间期的比值（PCI）评价激动在房内传导的变化。结果：29例靶点位于右房，8例位于左房。左房房速在下壁导联 P波振幅显著增高。源于冠状窦口、无冠窦和右房侧壁的PCI显著减小（P<0.05）。上腔静脉、右心耳和右房后壁的PRI和PCI数值在各部位中最大。结论：（1）aVL和V1导联P波形态对区分左房和右房房速最有意义；（2）Ⅱ、Ⅲ、aVF导联可为起源点位于上下提供线索；（3）PRI、PCI指数有助于房速起源的判定。

关键词: 房性心动过速, 体表心电图, P波, 定位, 射频消融

Abstract: Abstract Objectives:This study sought to construct an algorithm to differentiate left atrial from right atrial tachycardia foci on the basis of surface electrocardiograms (ECGs). The present study therefore sought to analyze P wave configuration in patients with atrial tachycardia who underwent successful catheter ablation, Our goal was to differentiate ectopic foci originating in left or right atrium on the basis of surface ECG findings. Methods: A total of 37 patients with atrial tachycardia due to either abnormal automaticity or triggered rhythm underwent detailed atrial endocardial mapping and successful radiofrequency ablation of a single atrial focus. To calculate the PRI index ( PR interval/PP interval) evaluated the variation of conduction upon the atrioventricular and to calculate the PCI index ( P width/PR interval) evaluated the variation of conduction in atrial.Results:In 29 patients, the tachycardia was located in the right atrium,and 8 was in the left atrium.Analysis of P wave configuration showed that leads aVL and V1 were most helpful in distinguishing right atrial from left atrial foci. The amplitude of lead II III and aVF are prominently larger in left atrial tachycardia. The PCI values which was located in coronary sinus, Nor-coronary sinus and lateral wall are 0.23, 0.26 and 0.24. There is significant less than other sites of tachycardia, P <0.05. The PRI and PCI values of right atrial appendage, and right superior pulmonary veins are mostly in all sites (p<0.05), 0.49 and 0.55 in right atrial appendage, 0.51 and 0.43 in posteroinferior right atrium, and right superior pulmonary veins are 0.47 and 0.53. Conclusions: 1) P waves in lead I and aVL were most helpful in distinguishing right atrial from left atrial foci. 2) Leads II, III and aVF were helpful in providing clues for differentiating superior from inferior foci. 3) PCI and PRI index was helpful to predict site of tachycardia origin.

Key words: Atrial tachycardia, ECG, P wave, Site origin, Radiofrequency ablation