房室结折返性心动过速的某些特性

Physiological properties of atrioventricular nodal reentrant tachycardias.

目的探讨房室结折返性心动过速(诱发的)的一些特性。方法97例(男42例,女55例,年龄45.34±15.0岁,平均15～76岁。)房室结折返性心动过速(AVNRT)患者,消融前后,一般程序刺激诱发组(n=70)及采用异丙肾上腺素后程序刺激诱发组(n=27),进行心内电生理检查,观察2组的性别、年龄、房室结电生理特性差异及消融复发率。结果97例患者中,70例(72%,95%CI:63%～81%)可诱发室性心动过速(SVT),消融后观察30min,心内电生理不能诱发;27例(28%,95%CI:19～38%)消融前不能诱发SVT,静滴异丙肾上腺素后,再重复心内电生理,能够诱发SVT,消融后观察30min,静滴异丙肾上腺素后,再重复心内电生理,仍无SVT。2组在性别年龄消融复发率方面差异无统计学意义;但房室结前传电生理特性方面有差异,即一般刺激诱发组快慢径路之间有效不应期(ERP)差异有统计学意义(312±78vs253+66,p<0.001);而加用异丙肾上腺素后刺激诱发组基础快慢径ERP差异无统计学意义(350±60vs330±50,p>0.05)。结论本文结果显示,程序刺激是否诱发AVNRT,与患者的性别、年龄无关,而与患者的房室结前传功能有关,即快慢径路前向传导的有效不应期相差越大,则越易发生AVNRT。消融实践中,如一般刺激不能诱发,可静滴异丙肾上腺素后再行程序刺激诱发,这对判断AVNRT消融成功终点,减?

Objective To assess the properties of atrioventricular nodal reentrant tachycardias (AVNRT). Methods 97 patients with AVNRT(42 men and 55 women, mean age 45.3±15.0 years, range 15～76 years) were studied. Electrical stimulations were performed without and with isoproterenol before and after radiofrequency catheter ablation (RFCA). Result Among 97 patients, AVNRT was inducible in 70 patients without use of isoproterenol but was not inducible after successful ablation in these 70 patients. After an initially successful ablation in the 27 patients who had inducible tachycardias with isoproterenol before ablation, no tachycardias could be re-induced with isoproterenol. No significant difference of ages, gender and recurrence of post-RFCA was found between two groups. However, there existed significant difference of physiological properties of AV node between two groups. Anterograde effective refractory period difference of the fast pathway and slow pathway in tow groups were 312±78ms vs 253±66ms p<0.001) and 350±60ms vs 330±50 ms (p>0.05) respectively. Conclusion Whether an AVNRT was inducible or not has something to do with physiological properties of AV node, the more difference between anterograde effective refractory period of the fast and slow pathway, the easier an AVNRT was inducible. For those patients who need isoproterenol to induce tachycardias before ablation, it is necessary to use it to control the success of AVNRT ablation.