P Wave Polarity During Pacing in Pulmonary Veins
P Wave Polarity During Pacing in Pulmonary Veins
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肺静脉起搏期间 P 波极性
DOI：
10.1023/a:1011429524859
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发表时间：
2001
影响因子：
1.8
通讯作者：
F. Morady
中科院分区：
文献类型：
--
作者：
H. Tse;C. Lau;Kathy Lai‐Fun Lee;F. Pelosi;H. Oral;B. Knight;S. Strickberger;F. Morady
摘要简介：最近的研究表明，引发心房颤动的过早除极经常发生在肺静脉中。本研究的目的是评估 P 波极性是否有助于区分 4 个肺静脉中的哪一个是过早除极的起源部位。
方法和结果：在 28 名接受阵发性心房颤动局灶性消融的无结构性心脏病的患者中，在窦性心律期间以及在高位右心房和 4 个肺静脉内以 500-600[emsp4]ms 周期起搏期间，对 12 导联心电图 (ECG) 上的 P 波极性进行了分析。 P 波分为正波、负波、双相波或等电波。 I 导联中的负性或双相 P 波（敏感性 85%，特异性 71%）或 V1 中的正性 P 波（敏感性 85%，特异性 89%）有助于预测肺静脉起源部位，而不是右心房起源部位。 II 和 III 导联中的正 P 波可区分上肺静脉和下肺静脉（敏感性 90%，特异性 84%）。 aVL 导联中的负性或双相 P 波在区分左右肺静脉起源部位时的敏感性和特异性分别为 94% 和 42%。
结论：P 波极性分析可能有助于定位肺静脉（过早除极的起源部位）。在 12 条 ECG 导联中，I、II、III、aVL 和 V1 对肺静脉中出现的过早去极化的区域化最有帮助。
AbstractIntroduction: Recent studies have demonstrated that premature depolarizations that trigger atrial fibrillation often arise in pulmonary veins. The purpose of this study was to evaluate whether P wave polarity is helpful in distinguishing which of the 4 pulmonary veins is the site of orgin of a premature depolarization.
Methods and Results: In 28 patients without structural heart disease who underwent focal ablation of paroxysmal atrial fibrillation, P wave polarity on a 12-lead electrocardiogram (ECG) was analyzed during sinus rhythm, and during pacing at a cycle lengh of 500–600[emsp4 ]ms in the high right atrium and within each of the 4 pulmonary veins. P waves were categorized as positive, negative, biphasic or isoelectric. A negative or biphasic P wave in lead I (sensitivity 85 %, specificity 71 %) or a positive P wave in V1 (sensitivity 85 %, specificity 89 %) were helpful in predicting a pulmonary venous site of origin as opposed to a right atrial site of origin. A positive P wave in lead II and III distinguished superior from inferior pulmonary veins (sensitivity 90 %, specificity 84 %). The sensitivity and specificity of negative or biphasic P waves in lead aVL in distinguishing a left from right pulmonary vein site of origin were 94 % and 42 %, respectively.
Conclusions: Analysis of P waves polarity may be helpful in localizing the pulmonary vein that is the site of origin of a premature depolarization. Among the 12 ECG leads, I, II, III, aVL, and V1 are the most helpful in regionalizing premature depolarizations arising in the pulmonary veins.