房室折返性心动过速合并房室结双径路的射频消融治疗

Radiofrequency Ablation of Atrioventricular Reentrant Tachycardia with Atrioventricular Nodal Dual Pathways

目的:探讨房室折返性心动过速(AVRT)合并房室结双径路(AVNDP)的电生理特征和射频消融术式的选择。方法:对640例阵发性室上性心动过速(PSVT)进行电生理检查,观察PSVT发作时传导的顺序,然后进行消融治疗。结果:640例PSVT中检出AVRT+AVNDP 68例,检出率为10.6%;有8例诱发房室结折返性心动过速,对此类患者进行慢径消融治疗。随访所有经治患者均无复发。结论:AVRT合并AVNDP者阻断房室旁道是消融成功的关键;房室旁道作为"旁观者"时也应作房室旁道消融;如仅有(AH)跳跃但无心动过速者无需接受房室结改良。

Objective：To examine the electrophysiological characteristics of atrioventrJcular reentrant tachycardia（AVRT） with atrioventricular nodal dual pathways（AVNDP） and evaluate the criteria for radiofrequency catheter ablation. Methods：Electrophysiological study was performed in 640 patients with paroxysmal supraventricular tachycardia （PSVT）. The antegrade and retrograde conduction pathways were examined, and the atrioventricular pathway or slow pathway （SP） was ablated if necessary. Results： Among the 640 patients with PSVT, 68 patients （10.6%） with DAVNP and AVRT were found. Of the 8 patients, the reentrant pattern with antegrade conduction by SP and atrioventricular nodal reentrant tachycardia （AVNRT） was induced. Radiofrequency ablation of AVRT was performed on all patients and ablation of SP was performed on 8 patients with the initiation of AVNRT. No recurrence was found during follow-up. Conclusion：It is crucial to break the conduction of atrioventricular pathway （AP） in patients with AVRT and AVNDP. The bystander AP should be ablated also. It seems unnecessary to modify the AVN if patients only with the AH jump and no AVNRT.