射频消融慢径治疗程控刺激不能诱发的房室结折返性心动过速

Radiofrequency catheter ablation of slow pathway in patients with dual atrioventricular node pathway and a documented but noninduclble atrloventricular nodal reentrant tachycardia

目的评价程控刺激不能诱发的房室结折返性心动过速（AVNRT）射频消融慢径的临床疗效。方法35例有阵发性室上性心动过速病史且疑诊为AVNRT的患者（A组）。电生理检查有房室结双径（DAVNP）但不能诱发AVNRT，在基础状态和静脉滴注异丙肾上腺索后有18例患者程控刺激可诱发出单个心房回波。4例患者程控刺激可诱发出2个心房回波，35例患者均进行射频消融慢径治疗。从同期接受射频消融的有自发心动过速且程控刺激可诱发AVNRT的患者中随机抽取35例作为对照组（B组）。比较A组和B组患者的临床和电生理特征，术后均进行随访。结果两组患者临床及电生理特征比较差异无统计学意义。射频消融慢径治疗后随访（32.2±13．9）个月，A组1例于术后4个月复发阵发性室上性心动过速，B组无一例复发，两组间复发率比较差异无统计学意义（P〉0．05）。结论有阵发性室上性心动过速病史且心电图疑诊为AVNRT，电生理检查有DAVNP但不能诱发AVNRT者，射频消融慢径治疗具有良好的临床疗效。

Objective To assess the efficacy of radiofrequency catheter ablation of slow pathway in patients with dual atrioventricular node pathway （DAVNP） and a documented but noninducible atrioventrioular nodal reentrant tachycardia （AVNRT）. Methods Seventy patients with clinically documented AVNRT who underwent successful radiofrequency ablation （RFCA） were included. Patients were divided into two groups. Thirty-five patients in group A were who had DAVNP with documented but nonindueible AVNRT. Clinical and electrophysiological characteristics of group A patients were compared with 35 patients with dual atrioventricular node pathway but inducible AVNRT （group B）. Results There was no significant difference in the clinical characteristics and electrophysiological properties of the fast and slow pathways between the two groups. Catheter ablation eliminated the slow pathway in all patients. During （32.2 ± 13.9） months follow-up after the ablation procedure, AVNRT recurrence was observed in 1 of the 35 patients （2.9%） in group A. In group B , there was no recurrence of AVNRT.The recurrence rate between two groups was no significant difference. Conclusions Slow pathway ablation with radiofrequency is highly effective in patients with clinically documented AVNRT and dual atrioventricular nodal pathway during electrophysiological study but without inducible tachycardia.