SA-VA间期对阵发性室上性心动过速的鉴别价值
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摘要
目的探讨右室基底段心室拖带时刺激-心房(SA)间期与原心动过速时心室-心房(VA)间期的差值,即SA-VA间期对房室折返性心动过速(atrioventricular reentrant tachycardia,AVRT)与房室结折返性心动过速(atrioventricular nodal reentrant tachycardia,AVNRT)的鉴别价值。方法选取67例体表心电图无明显预激波的窄QRS心动过速患者,在右室基底段拖带心动过速。测量SA-VA间期、拖带后校正回归间期(即校正的起搏后间期与心动过速周长的差值)等电生理参数,并比较其鉴别阵发性室上性心动过速机制的有效性。结果旁道介导AVRT共19例,其中游离壁旁道13例,间隔旁道6例; AVNRT共48例,其中典型35例,不典型13例。校正回归间期> 95 ms诊断AVNRT和AVRT的敏感性、特异性、阳性预测值和阴性预测值分别为90%、90%、96%和78%;而SA-VA间期> 80 ms诊断二者的敏感性、特异性、阳性预测值和阴性预测值分别为94%、84%、94%和85%。其中SA-VA间期≤50 ms鉴别间隔旁道介导AVRT和不典型AVNRT的敏感性、特异性均能达到100%。结论在右室基底段心室拖带下,SA-VA间期能够简便、有效地鉴别AVRT与AVNRT。
Objective To discuss the value of the difference of pacing entrained stimulus-auricle( SA) interval and tachycardia ventriculoatrial( VA) interval,that is,SA-VA interval,on differentiating between atrioventricular reentrant tachycardia( AVRT) and atrioventricular nodal reentrant tachycardia( AVNRT),during the tachycardia entrainment through trains of the basal segment of right ventricle. Methods We selected 67 patients with tachycardia and narrow QRS without obvious preexcitation wave on surface ECG. Tachycardia entrainment was attempted through trains of the basal segment of right ventricle. The electrophysiological parameters including SA-VA interval and the corrected regression cycle( the difference of corrected post-pacing interval and tachycardia circle length)after the entrainment were measured,and their efficacy of distinguishing between different mechanisms of paroxysmal supraventricular tachycardia was compared. Results There were 19 patients with accessory pathway mediated AVRT,using free-wall or septal accessory pathways( n = 13,6),respectively. There were 48 AVNRT patients in whom 35 were typical and 13 were atypical. The sensitivity,specificity,and positive and negative predictive valuesof the corrected regression cycle > 95 ms were separately 90%,90%,96% and 78% in differentiating between AVNRT and AVRT; however,these values were separately 94%,84%,94% and 85% for SA-VA interval >80 ms. And in the differential diagnosis of septal accessory pathway mediated AVRT and atypical AVNRT,the sensitivity and specificity of SA-VA interval≤50 ms could both reach as high as 100%. Conclusion SA-VA interval serves as an easy,simple and effective method for differentiating AVRT from AVNRT during the entrainment through trains of the basal segment of right ventricle.
Objective To discuss the value of the difference of pacing entrained stimulus-auricle( SA) interval and tachycardia ventriculoatrial( VA) interval,that is,SA-VA interval,on differentiating between atrioventricular reentrant tachycardia( AVRT) and atrioventricular nodal reentrant tachycardia( AVNRT),during the tachycardia entrainment through trains of the basal segment of right ventricle. Methods We selected 67 patients with tachycardia and narrow QRS without obvious preexcitation wave on surface ECG. Tachycardia entrainment was attempted through trains of the basal segment of right ventricle. The electrophysiological parameters including SA-VA interval and the corrected regression cycle( the difference of corrected post-pacing interval and tachycardia circle length)after the entrainment were measured,and their efficacy of distinguishing between different mechanisms of paroxysmal supraventricular tachycardia was compared. Results There were 19 patients with accessory pathway mediated AVRT,using free-wall or septal accessory pathways( n = 13,6),respectively. There were 48 AVNRT patients in whom 35 were typical and 13 were atypical. The sensitivity,specificity,and positive and negative predictive valuesof the corrected regression cycle > 95 ms were separately 90%,90%,96% and 78% in differentiating between AVNRT and AVRT; however,these values were separately 94%,84%,94% and 85% for SA-VA interval >80 ms. And in the differential diagnosis of septal accessory pathway mediated AVRT and atypical AVNRT,the sensitivity and specificity of SA-VA interval≤50 ms could both reach as high as 100%. Conclusion SA-VA interval serves as an easy,simple and effective method for differentiating AVRT from AVNRT during the entrainment through trains of the basal segment of right ventricle.
引文
[1]Benditt DG,Pritchett EL,Smith WM,et al.Ventriculoatrial intervals:diagnostic use in paroxysmal supraventricular tachycardia[J].Ann Intern Med,1979,91(2):161-166.
[2]Miller JM,Rosenthal ME,Gottlieb CD,et al.Usefulness of the delta HA interval to accurately distinguish atrioventricular nodal reentry from orthodromic septal bypass tract tachycardias[J].Am J Cardiol,1991,68(10):1037-1044.
[3]Dandamudi G,Mokabberi R,Assal C,et al.A novel approach to differentiating orthodromic reciprocating tachycardia from atrioventricular nodal reentrant tachycardia[J].Heart Rhythm,2010,7(9):1326-1329.
[4]Ormaetxe JM,Almendral J,Arenal A,et al.Ventricular fusion during resetting and entrainment of orthodromic supraventricular tachycardia involving septal accessory pathways.Implications for the differential diagnosis with atrioventricular nodal reentry[J].Circulation,1993,88(6):2623-2631.
[5]Veenhuyzen GD,Coverett K,Quinn FR,et al.Single diagnostic pacing maneuver for supraventricular tachycardia[J].Heart Rhythm,2008,5(8):1152-1158.
[6]Kadish AH,Morady F.The response of paroxysmal supraventricular tachycardia to overdrive atrial and ventricular pacing:can it help determine the tachycardia mechanism?[J].J Cardiovasc Electrophysiol,1993,4(3):239-252.
[7]徐秋霞.心室拖带中的室性融合波逆传心房对隐匿性间隔旁诊断价值的研究[J].中国心血管病研究杂志,2005,3(11):813-815.
[8]Martinez-Alday JD,Almendral J,Arenal A,et al.Identification of concealed posteroseptal Kent pathways by comparison of ventriculoatrial intervals from apical and posterobasal right ventricular sites[J].Circulation,1994,89(3):1060-1067.
[9]Boyle PM,Veenhuyzen GD,Vigmond EJ.Fusion during entrainment of orthodromic reciprocating tachycardia is enhanced for basal pacing sites but diminished when pacing near Purkinje system end points[J].Heart Rhythm,2013,10(3):444-451.
[10]Calvo D,Avila P,Garcia-Fernandez FJ,et al.Differential responses of the septal ventricle and the atrial signals during ongoing entrainment:a method to differentiate orthodromic reciprocating tachycardia using septal accessory pathways from atypical atrioventricular nodal reentry[J].Circ Arrhythm Electrophysiol,2015,8(5):1201-1209.
[11]Gonzalez-Torrecilla E,Arenal A,Atienza F,et al.First postpacing interval after tachycardia entrainment with correction for atrioventricular node delay:a simple maneuver for differential diagnosis of atrioventricular nodal reentrant tachycardias versus orthodromic reciprocating tachycardias[J].Heart Rhythm,2006,3(6):674-679.
[12]Boonyapisit W,Methavigul K,Krittayaphong R,et al.Determining the site of accessory pathways in orthodromic reciprocating tachycardia by using the response to right ventricular pacing[J].Pacing Clin Electrophysiol,2016,39(2):115-121.
[13]Michaud GF,Tada H,Chough S,et al.Differentiation of atypical atrioventricular node re-entrant tachycardia from orthodromic reciprocating tachycardia using a septal accessory pathway by the response to ventricular pacing[J].JAm Coll Cardiol,2001,38(4):1163-1167.
[14]Issa ZF,Miller JM,Zipes DP.临床心理失常与电生理学---《Braunwald心脏病学》姊妹卷[M].吴永全,张树龙,译.2版.北京:北京大学医学出版社,2014:488-506.
[15]Ormaetxe JM,Almendral J,Arenal A,et al.Ventricular fusion during resetting and entrainment of orthodromic supraventricular tachycardia involving septal accessory pathways:implications for the differential diagnosis with atrioventricular nodal reentry[J].Circulation,1993,88(6):2623-2631.
[16]Reddy VY,Jongnarangsin K,Albert CM,et al.Para-Hisian entrainment:a novel pacing maneuver to differentiate orthodromic atrioventricular reentrant tachycardia from atrioventricular nodal reentrant tachycardia[J].J Cardiovasc Electrophysiol,2003,14(12):1321-1328.
[17]Ho RT,Mark GE,Rhim ES,et al.Differentiating atrioventricular nodal reentrant tachycardia from atrioventricular reentrant tachycardia by delta HA values during entrainment from the ventricle[J].Heart Rhythm,2008,5(1):83-88.
[18]Gonzalez-Torrecilla E,Almendral J,Garcia-Fernandez FJ,et al.Differences in ventriculoatrial intervals during entrainment and tachycardia:a simpler method for distinguishing paroxysmal supraventricular tachycardia with long ventriculoatrial intervals[J].J Cardiovasc Electrophysiol,2011,22(8):915-921.
[2]Miller JM,Rosenthal ME,Gottlieb CD,et al.Usefulness of the delta HA interval to accurately distinguish atrioventricular nodal reentry from orthodromic septal bypass tract tachycardias[J].Am J Cardiol,1991,68(10):1037-1044.
[3]Dandamudi G,Mokabberi R,Assal C,et al.A novel approach to differentiating orthodromic reciprocating tachycardia from atrioventricular nodal reentrant tachycardia[J].Heart Rhythm,2010,7(9):1326-1329.
[4]Ormaetxe JM,Almendral J,Arenal A,et al.Ventricular fusion during resetting and entrainment of orthodromic supraventricular tachycardia involving septal accessory pathways.Implications for the differential diagnosis with atrioventricular nodal reentry[J].Circulation,1993,88(6):2623-2631.
[5]Veenhuyzen GD,Coverett K,Quinn FR,et al.Single diagnostic pacing maneuver for supraventricular tachycardia[J].Heart Rhythm,2008,5(8):1152-1158.
[6]Kadish AH,Morady F.The response of paroxysmal supraventricular tachycardia to overdrive atrial and ventricular pacing:can it help determine the tachycardia mechanism?[J].J Cardiovasc Electrophysiol,1993,4(3):239-252.
[7]徐秋霞.心室拖带中的室性融合波逆传心房对隐匿性间隔旁诊断价值的研究[J].中国心血管病研究杂志,2005,3(11):813-815.
[8]Martinez-Alday JD,Almendral J,Arenal A,et al.Identification of concealed posteroseptal Kent pathways by comparison of ventriculoatrial intervals from apical and posterobasal right ventricular sites[J].Circulation,1994,89(3):1060-1067.
[9]Boyle PM,Veenhuyzen GD,Vigmond EJ.Fusion during entrainment of orthodromic reciprocating tachycardia is enhanced for basal pacing sites but diminished when pacing near Purkinje system end points[J].Heart Rhythm,2013,10(3):444-451.
[10]Calvo D,Avila P,Garcia-Fernandez FJ,et al.Differential responses of the septal ventricle and the atrial signals during ongoing entrainment:a method to differentiate orthodromic reciprocating tachycardia using septal accessory pathways from atypical atrioventricular nodal reentry[J].Circ Arrhythm Electrophysiol,2015,8(5):1201-1209.
[11]Gonzalez-Torrecilla E,Arenal A,Atienza F,et al.First postpacing interval after tachycardia entrainment with correction for atrioventricular node delay:a simple maneuver for differential diagnosis of atrioventricular nodal reentrant tachycardias versus orthodromic reciprocating tachycardias[J].Heart Rhythm,2006,3(6):674-679.
[12]Boonyapisit W,Methavigul K,Krittayaphong R,et al.Determining the site of accessory pathways in orthodromic reciprocating tachycardia by using the response to right ventricular pacing[J].Pacing Clin Electrophysiol,2016,39(2):115-121.
[13]Michaud GF,Tada H,Chough S,et al.Differentiation of atypical atrioventricular node re-entrant tachycardia from orthodromic reciprocating tachycardia using a septal accessory pathway by the response to ventricular pacing[J].JAm Coll Cardiol,2001,38(4):1163-1167.
[14]Issa ZF,Miller JM,Zipes DP.临床心理失常与电生理学---《Braunwald心脏病学》姊妹卷[M].吴永全,张树龙,译.2版.北京:北京大学医学出版社,2014:488-506.
[15]Ormaetxe JM,Almendral J,Arenal A,et al.Ventricular fusion during resetting and entrainment of orthodromic supraventricular tachycardia involving septal accessory pathways:implications for the differential diagnosis with atrioventricular nodal reentry[J].Circulation,1993,88(6):2623-2631.
[16]Reddy VY,Jongnarangsin K,Albert CM,et al.Para-Hisian entrainment:a novel pacing maneuver to differentiate orthodromic atrioventricular reentrant tachycardia from atrioventricular nodal reentrant tachycardia[J].J Cardiovasc Electrophysiol,2003,14(12):1321-1328.
[17]Ho RT,Mark GE,Rhim ES,et al.Differentiating atrioventricular nodal reentrant tachycardia from atrioventricular reentrant tachycardia by delta HA values during entrainment from the ventricle[J].Heart Rhythm,2008,5(1):83-88.
[18]Gonzalez-Torrecilla E,Almendral J,Garcia-Fernandez FJ,et al.Differences in ventriculoatrial intervals during entrainment and tachycardia:a simpler method for distinguishing paroxysmal supraventricular tachycardia with long ventriculoatrial intervals[J].J Cardiovasc Electrophysiol,2011,22(8):915-921.