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刺激信号至QRS波起始与RR间期比值对房室结折返性心动过速患者慢径路的检测作用

Detective Value of SR/RR Interval Ratio to the Patients With Slow Pathway Atrioventricular Nodal Reentrant Tachycardia
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摘要 目的 :评估保持 1∶1房室传导的最快心房刺激时 ,刺激信号至QRS波起始 (SR)与RR间期的比值 (SR/RR) ,对房室结折返性心动过速 (AVNRT)患者前传慢径路的诊断价值。方法 :将 12 7例患者分为两组 :①AVNRT组 79例〔按心房期前刺激时房室结前传曲线的特点又分为房室结前传曲线中断 (AH间期的跳跃值大于 5 0ms)者 5 6例和房室结前传曲线连续 (无AH间期的跳跃 )者 2 3例〕 ;②房室折返性心动过速组 (AVRT组 ) 48例。测量快速心房刺激时 (高位右心房 )的SR及RR间期 ,计算SR/RR比值。结果 :消融前 ,AVNRT组与AVRT组相比 ,其SR/RR比值相差较大 ,有显著性差异 (P≤ 0 0 5 ) ,消融后 ,AVNRT组的SR/RR比值变化较消融前为明显 (P≤ 0 0 1) ,而AVRT组较消融前则并无明显改变 ,两组间无差异 (P >0 0 5 )。SR/RR比值大于 1时 ,诊断慢径前传的特异性可达 91% ,敏感性为 81% ,阳性预测值为 90 % ,阴性预测值为 93%。结论 :快速心房起搏时能稳定保持 1∶1房室传导的最大SR/RR比值是显露房室结慢径前传的一个既简单又有效的可靠方法 。 Objective: The aim of our study was to evaluate whether the detective value of SR/RR interval ratio during rapid atrial pacing at the maxium rate of sustained 1∶1 AV conduction can demonstrate the slow pathways in patients with atrioventricular nodal reentrant tachycardia (AVNRT). Methods: All patients were divided into two groups: ①AVNRT group( n =79, including 56 with a discontinuous AV nodal anterograde conduction curve and with the AH interval increased at least 50ms during atrial extrastimulus testing and 23 with a continous AV nodal anterograde conduction curve, but the inducible arrhythmia being still typical AVNRT); ②AVRT group ( n =48, who had undergone ablation accessory pathways, and had no inducible AVNRT). We measured SR and RR intervals or the ratio of SR/RR during rapid atrial pacing at the maxium rate of sustained 1∶1 AV conduction in both groups. Results: Before ablation, the SR/RR ratios between the two groups were significantly different ( p ≤0.05). After ablation, the ratio only in AVNRT group changed significantly( p ≤0.01), but that in AVRT group did not ( p ≥0.05). The ratio of SR/RR>1.0 was 81% sensitive for inducible AVNRT,especially demonstrating the anterograde conduction of slow AV nodal pathway, The positive and negative predictive values were 91% and 93%,respectively. Conclusion:The ratio of the SR interval to the RR interval during rapid atrial pacing at the maxium rate of sustained AV conduction provides a simple and useful method for determining the presence of slow AV nodal pathway conduction.This finding may be particularly useful in patients with inducible AV nodal reentry but without discontinuous AV nodal conduction curve on atrial extrastimulus testing
出处 《中国循环杂志》 CSCD 北大核心 2002年第6期418-420,共3页 Chinese Circulation Journal
关键词 房室结折返性心动过速 慢径前传 SR/RR 诊断 临床意义 心电图 Atrioventricular node SR/RR ratio Slow pathway
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