射频消融术中快速诊断隐匿性后间隔旁路的体会

The Experience with Rapid Diagnosis of Concealed Posteroseptal Accessory Pathway During Radiofrequency Catheter Ablation

介绍一种新的电生理方法可快速准确地诊断隐匿性后间隔旁路。方法：右室心尖部和基底部起搏，比较１２例隐匿性后间隔旁路（Ａ组）和２０例房室结双径路（Ｂ组）患者的室房传导时间（ＶＡＩ）。结果：①心尖部起搏时Ａ组ＶＡＩ（１８６±３９）ｍｓ与Ｂ组（１７１±３２）ｍｓ相比，无显著性差异（Ｐ＞０．０５）；②基底部起搏时Ａ组ＶＡＩ（１４４±３１）ｍｓ明显短于Ｂ组（１９４±３３）ｍｓ；两者有显著性差异（Ｐ＜０．０１）；③两部位（心尖部和基底部）ＶＡＩ之差值ＶＡｉｎｄｅｘ，Ａ组≥１０［１０～８０，平均（３０±２６）］与Ｂ组≤０［－５５～０，平均（－２３±１６）］比较有极显著性差异（Ｐ＜０．００１）。结论：右室心尖部和基底部起搏可快速准确地判断室房逆传径路是后间隔旁路还是房室束。

A new simple electrophysiological method to rapidly and accurately diagnose concealed posteroseptal accessory pathway was introduced. Using decremental pacing from apical and posterobasal right ventricular site, ventriculoatrial interval (VAI) between 12 patients with concealed posteroseptal accessory pathway (group A) and 20 patients with atrioventricular nodal reentrg tachycardia (group B) were compared. During apical pacing, VAI in group A (186±39) ms was not significantly different from that in group B (171±32 ms, P >0.05). During posterobasal pacing, group A had significantly shorter VAI than group B (144± 31 ms versus 194±33 ms, P <0.01). The difference between the VAI, obtained during apical pacing and that obtained during posterobasal pacing (VA index ) can discriminate between these two groups without overlapping. It was positive in all group A patients (30±26, range, 10￣80) and negative in all except three group B patients (-23±16, range, -55￣0, P <0.001). Right ventricular pacing from apical and posterobasal sites can identify rapidly and accurately whether the retrograde conduction is proceeding over posteroseptal accessory pathway or the normal atrioventricular node.