显性预激综合征与房室折返性心动过速100例分析

Preexciation Syndrome and Atrioventricular Reentrant Tachycardia:Reports of 100 Cases

分析１００例显性预激综合征食管心房调搏的资料，结果表明：①诱发顺向型房室折返性心动过速（Ｏ－ＡＶＲＴ）４９例，左侧旁道（ＡＰ）较右侧ＡＰ发生率高；逆向型房室折返性心动过速（Ａ－ＡＶＲＴ）３例，均见于右侧ＡＰ。前向与逆向的单次折返１３例。房室折返性心律失常总计６５例，占６５％。②Ｏ－ＡＶＲＴ的形成应具备旁道前传的有效不应期（ＡＰＡ－ＥＲＰ）＞房室结有效不应期（ＡＶＮ－ＥＲＰ）＞左房有效不应期（ＬＡ－ＥＲＰ）。Ａ－ＡＶＲＴ的形成，应具备ＡＶＮ－ＥＲＰ＞ＡＰＡ－ＥＲＰ＞ＬＡ－ＥＲＰ。③房室折返性心动过速的诱发以Ｓ_１Ｓ_２及分级递增法为最佳。

According to Rosenbaum,Gallagher and Reddly body surface electrocardiogram critias,the results of transesophagal atrial pacing about 100 patients with preexciation syndrome were analyzed.Orthodromic(O-)atrioventricular reentrant tachycardia(AVRT),antidromic(A-)AVRT,sigle orthodromic reentry,and sigle antidromic reentry were respectivelly induced by atrial pacing in 49,3,7.6 patients.There was a significant different in the induction of OAVRT between the patients with left accessory pathway(AP)(38/56,67.9%)and the patients with right AP(11/44,25.0%).All of A-AVRT were induced in 3 patients with right AP and the O-AVRT complicated functional bundle block in 14 patinets(14/49,28.6%).For the occurrence of O-AVRT,effective refractory period(ERP)of AP must be longer than ERP of AVN and ERP of Atrioventricular node(AVN)must be longer than ERP of left atrum.For the occurrence of A-AVRT and ERP of AVN must be longer than ERP of left atrum.The best inducing methods could be S1S2 and increment pacing.For the inducing of AVRT,the most important factors may be conduction function of AVN and antidromic conduction ability of AP.