房室结折返性心动过速射频消融后的电生理改变与复发率的关系

Correlation between electrophysiological parametrs changes and the recurrence rale of atrioventricular nodal reentrant tachycardia

目的：探讨房室结折返性心动过速（ＡＶＮＲＴ）射频消融术后的电生理改变及不同手术终点与复发率的关系。 方法：本组５６ 例ＡＶＮＲＴ患者慢径消融前、后作各项电生理参数测定，并随访观察远期疗效。 结果：３８ 例慢径消失者（Ａ组）无一例复发，残存慢径１２ 例（Ｂ组）有一例复发（８．３３％ ），残存慢径有１～２ 个心房回波者６例（Ｃ组）有２例复发（３３．３％ ）。５３ 例无复发者消融前后的房室束最大值（Ａ－Ｈｍ ａｘ ）分别为（２８０±２７）和（１９６±５６）ｍ ｓ（Ｐ＜０．０１），快径不应期分别为（３３０±４４）和（２８７±３１）ｍ ｓ（Ｐ＜ ０．０１）。而３ 例复发者消融前、后的Ａ－Ｈｍ ａｘ分别为（２８７±３１）和（２６２±３８）ｍ ｓ（Ｐ＞ ０．０５），快径不应期分别为（３２４±３８）和（３１３±２８）ｍ ｓ（Ｐ＞ ０．０５）。 结论：ＡＶＮＲＴ的复发与慢径残存和Ａ－Ｈｍ ａｘ 及快径不应期无明显改变有关。

Objectives:The study is intend to discuse the correlation between the different electrophysiological ends and the recurrence rate of AVNRT after RFCA. Methods:RFCA was performed in 56 patients of AVNRT and cardiac electrophysiological parameters were measured before and after operation.The recurrence rate of AVNRT was investigated in follow up duration. Results:38 patients who slow pathway disappeared after RFCA(Group A) had no one recurrence of AVNRT.12 patients remaining slow pathway without an atrial echo(Group B) had 1 patient(8.33%) recurrence of AVNRT.6 patients remaining slow pathway with one to two atrial echo(Group C) had 2 patients(33.3%) recurrence of AVNRT.In 53 patient without recurrence of AVNRT after RFCA,the A H max interval and fast pathway refractory periods decreasd from (287±27) ms to (196±56) ms( P <0.01) and (330±44) ms to (287±31) ms( P< 0.01 ) respectively.While in 3 patient;with AVNRT recurrenced,there are no significant changes in A H max interval (287±31 ms vs 262±38 ms, P >0.05) and fast pathway refractory periods (324±35 vs 313±28 ms, P >0.05). Conclusions:There was a closer correlation between recurrence rate of AVNRT and remining slow pathway.Besides,no significant changes of A H max after RFCA was also a recurrent factor.