射频消融房室结改良消融前后心脏电生理变化的探讨

Change of electrophysiology before and after AV node modification by selective RF ablation of AV node pathway

目的比较房室结双径路伴房室结内折返性心动过速(AVNRT)患者,射频消融(RFCA)慢径路改良术,消融前、后心脏各部分腔内电生理改变。方法在相同条件下,于消融前、后分别进行腔内电生理检查。记录消融前、后:希氏束电图(HIS),心房有效不应期(A—ERP),功能不应期(A—FRP),心室有效不应期(V—ERP),功能不应期(V—FRP),房室结前传有效不应期(AVN—ERP),前传文氏点(AVN—WKB),房室结逆传有效不应期(VAN—ERP),逆传文氏点(VAN—WKB),将消融前、后心脏各部分电生理参数进行配对,经SPSS统计分析软件进行T检验分析。结果消融前、后:HIS电图,A—ERP,A—FRP,V—ERP,V—FRP,AVN—ERP,及VAN—WKB均无显著差异(P>0.05)。AVN—WKB,VAN—ERP有显著差异(P<0.05)。讨论射频消融房结改良对房室结双径路AVNRT疗效肯定。在消融前、后(急性期)房室结前、逆传电生理均有一定改变。这与消融改变了房室结的部分结构,如大部分病列慢径路消失有关。不同消融部位对房室结传导电理改变产生不同的结果。没有证据表明消融后,45岁以上年龄组房室结传导改变大于45岁以下年龄组。男女不同性别组之间亦无差异。

Object To compared difference of electrophysiology before and after AV node modification by selective RF ablation of slow AV node pathway.Method During the procedure,record electrophysiologic parameters before and after radiofrequency catheter ablation at baseline:Bundle of HIS,Atrial FRP,Atrial FRP.Ventricular ERP,Ventrcular FRP.AV node Wenckebach,AV node ERP,VA node ERP,VA node Wenckebach.Paired each of electrophysiologic parameters before and after RF ablation.Analyzed in T test with SPSS software.Results There are no significant difference among Bundle of HIS,Atrial ERP,Atrial FRP.V-ERP,V-FRP.AVN-ERP and VAN-WKB(P>0.05).But singnificant difference in AVN-WKB and VAN-ERP(P<0.05)pre and post ablation.Conclusion There are certain effect in AVNRT with AV node modification by selective RF ablation of slow AV node pathway.Study shows some changes of anterograde conduction and retrograde conduction in AV node pre and post ablation during the procedure.One of Possibility is some constructional changes of AV node post ablation.Constructional changes of AV node depend on the position of ablation.no evidence of any difference between above 45 years old group and below 45 years old group before and after ablation.Same as different sex group.