aVL切迹论文：aVL切迹房室结折返性心动过速房室折返性心动过速阵发性室上性心动过速

aVL切迹论文：aVL切迹房室结折返性心动过速房室折返性心动过速阵发性室上性心动过速
【中文摘要】探讨体表心电图aVL导联对房室结折返性心动过速(AVNRT)的鉴别作用,为临床选择合理的处理方案和射频消融治疗提
供指导。

对178例连续的阵发性室上性心动过速(PSVT)患者的心电图进行分析。

第一部分分析112例患者的心电图,其中房室结折返性心动过速(AVNRT)组60例,房室折返性心动过速(AVRT)组52例。

观察标准心电图算法(V1导联伪r及下壁导联伪s波)、aVR导联ST段抬高、QRS电交替和aVL导联切迹在两组病例中出现的频率和类型。

第二部分前瞻性分析66例阵发性室上性心动过速患者的心电图,检测aVL导联终末切迹诊断房室结折返性心动过速的敏感性和特异性,并与标准心电图算法(V1导联伪r及下壁导联伪s波)诊断房室结折返性心动过速的敏感性和特异性进行比较,评价aVL导联终末切迹对房室结折返性心动过速和房室折返性心动过速的鉴别作用。

1. AVNRT与AVRT 在年龄上没有差异(45.1±16.2和45.3±14.0,P=NS),但是AVNRT中女性患者的比例多于AVRT(55.0%和32.7%,P=0.04)。

2.aVL终末切迹与标准心电图算法(V1导联伪r及下壁导联伪s波)发生在AVNRT的比例均大于AVRT(aVL切迹：53.3%和17.3%,P=0.0008；V1导联伪R 波：46.7%和15.4%,P=0.0022；下壁导联伪S波：41.7%和
5.8%,P=0.0001)。

3.aVR导联ST段抬高发生在AVRT的比例大于AVNRT(71.2%和3
6.7%,P=0.0001),并且73.0%为左侧旁道。

4.QRS波电交替在AVRT和AVNRT间没有统计学差异(1
7.3%和11.7%,P=NS)。

5.aVL导联终末切迹和V1导联伪R及下壁导联伪S波诊断AVNRT的敏感性和特异性分别为50.0%和80.0%、47.2%和93.6%、33.3%和9
6.7%。

6.aVL导联终末切迹诊断AVNRT的敏感性高于标准心电图算法(V1导联伪r及下壁导联伪s波),但是三者之间没有统计学差异。

1.aVL导联终末导联切迹见于AVNRT。

2.aVL导联终末切迹对AVNRT
的鉴别诊断具有和标准心电图算法(V1导联伪r及下壁导联伪s波)相同的敏感性和特异性。

3.aVL导联终末切迹可以作为鉴别AVNRT和AVRT新的心电图算法。

【英文摘要】【】Explore the differential utility of aVL lead for atrioventricular nodal re-entrant tachycardia to provide guides for the clinical treatment and radiofrequency ablation.【Methods】One hundred and seventy-eight consecutive patients referred for paroxysmal supraventricular tachycardia(PSVT) were evaluated. The first part, One hundred and twelve patients electrocardiogram(ECG)were analysised, including sixty atrioventricular nodal re-entrant tachycardia(AVNRT) and fifty-two atrioventricular re-entrant tachycardia(AVRT) to observe the frequency and type of standard
criireria(pseudo-s-wave in lead V1 or pseudo-s-wave in the inferior lesds) ST-segment elevation in aVR lead、QRS alternans and aVL lead notch. The second part, sixty-six patients ECG were analysised prospectively to check the sensitivity and
specificity of the aVL lead notch and compare it with the standard criireria(pseudo-r-wave in lead V1 or pseudo-s-wave in the inferior lesds), evalued the utility of aVL notch in the diagnosis of AVNRT and AVRT.[Results]1.There are no statistical significance between AVNRT and AVRT in age (45.1±16.2 and 45.3±14.0, P=NS), but the female was found more frequently in AVNRT than in AVNT (55.0% and 32.7%,
P=0.04).2.The aVL notch and the standard criteria
(pseudo-r-wave in V1 and pseudo-s-wave in inferior) were found more frequently in AVNRT than in AVRT(aVL notch:53.3% and 17.3%, P=0.0008; pseudo-R-wave:46.7% and 15.4%, P=0.0022;
pseudo-S-wave:41.7% and 5.8%, P=0.0001).3.The ST-segment elevation in lead aVR was more frequently in AVRT than in AVNRT (71.2% and 36.7%, P=0.0001),73.0% were left side pathway.4.The QRS alternans have no statistical significance between AVRT and AVNRT (17.3% and 11.7%, P=NS).5.The aVL notch and pseudo r and s wave sensitivity and specificity to determine AVNRT were 50.0% and 85.0%、47.2% and 84.6%,33.3% and 96.7%, respectively.6.The aVL notch sensitivity to determine AVNRT was higher than standard criteria, although there was no statistical significance.[Conclusion]1.The presence of a notch in aVL lesd is more frequent in AVNRT.2.The aVL notch
appeared to be as sensitive and specific as the standard electrocardiographic criteria for the differential diagnosis of AVNRT.3.The aVL notch can be a new criteria in the differential diagnosis between AVNRT and AVRT.
【关键词】aVL切迹房室结折返性心动过速房室折返性心动过速阵发性室上性心动过速
【采买全文】1.3.9.9.38.8.4.8 1.3.8.1.13.7.2.1
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【说明】本文仅为中国学术文献总库合作提供，无涉版权。

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【英文关键词】aVL notch AV node re-entrant tachycardia AV re-entry tachycardia paroxysmal supraventricular tachycardia
【目录】体表心电图aVL导联对房室结折返性心动过速的鉴别作用中文摘要6-8Abstract8-9符号说明10-11前言
11-13资料与方法13-15结果15-19讨论19-27结论
27-28附图28-30参考文献30-34文献综述34-49参考文献44-49攻读学位期间发表的论文49-58致谢58-59学
位论文评阅及答辩情况表59。