avR导联假性r波或粗顿和ST段抬高在阵发性室上性心动过速鉴别中的价值

摘要

Objective To evaluate the pseudo-r' or notching and ST-segment elevation in avR lead in paroxysmal supraventricular tachycardia( PSVT) . Methods Electrophysiological testing and radiofrequency catheter ablation( RFCA) in 150 patients of PSVT were per-formed routinely, with AVRT 82 cases and AVNRT 68 cases. avR lead terminal QRS morphology and ST-segment elevation ( horizontal, up-slope type, and down-slope type) in sinus rhythm and ventricular tachycardia episodes were observed. Results Of 68 AVNRT cases, termi-nal portion of the QRS complex morphological change in avR lead had 50 cases(73. 5％), and AVNRT diagnostic sensitivity, specificity, and positive predictive values were 72. 0％, 82. 4％, 83. 1％, respectively. Of 82 AVRT cases, ST segment elevation in avR lead had 59 ca-ses(72. 0％), and AVRT diagnostic sensitivity, specificity and positive predictive values were 73. 5％, 94. 0％, 91. 0％, respectively. Conclusion Compared with sinus rhythm, avR lead pseudo-r'or notching and ST-segment elevation play an important role in the identifica-tion of ventricular tachycardia.%目的 探究avR导联在阵发性室上性心动过速(PSVT)中的鉴别诊断价值.方法 选取行射频消融的患者150例,分为房室折返性心动过速组(AVRT组n=82)和房室结折返性心动过速组(AVNRT组n=68),观察窦性心律及室上速发作时avR导联QRS波终末部形态(假r波或粗顿)和ST段抬高(水平型,上斜型,及下斜型)改变情况.结果 与窦性心律相比,AVRT组avR导联QRS波终末部形态改变共5例(6.0％),AVNRT组avR导联QRS波终末部形态改变有50例(73.5％), 差异有统计学意义(P＜0.05),其诊断AVNRT的敏感性、特异性和阳性预测值分别是72.0％、82.4％、83.1％;与窦性心律时相比,AVRT组avR导联ST段抬高的发生数为59例,AVNRT组avR导联ST段抬高的有12例,差异有统计学意义(P＜0.05),其诊断AVRT的敏感性、特异性和阳性预测值分别是73.5％、94.0％、91.0％ .结论 与窦性心律相比,avR导联假性r波或粗顿以及ST段抬高对判断PSVT的类型具有重要意义,有助于PSVT的鉴别诊断价值.