三磷酸腺苷在房室结折返性心动过速消融终点判定中的意义

Significance of Adenosine Triphosphate in Determination of Ablation Endpoint of Atrioventricular Nodal Reentrant Tachycardia

【目的】探讨三磷酸腺苷（adenosine triphosphate，ATP）在射频消融（radiofrequency cather abalation，RFCA）慢径治疗慢-快型房室结折返性心动过速（atrioventricular nodal reentrant tachycardia，AVNRT）消融终点判定中的意义。【方法】40例慢-快型AVNRT患者RFCA前经股静脉快速（2S内）注射ATP（0．15mg／kg起始量及每次增加0．1mg／kg），直至出现房室结双径路（dua atrioventricular nodal pathways，DAVNP）现象、Ⅱ度或Ⅲ度房室传导阻滞等。对ATP试验诊断有房室结双径路现象者RFCA慢径阻断成功后重复原ATP剂量，连续记录体表心电图和心内电图。【结果】RFCA前行ATP实验29例（72．5％）出现DAVNP现象，该29例患者RFCA慢径阻断成功后重复注射原ATP剂量，均无DAVNP现象。【结论】ATP是诊断DAVNP的一个判定指标，如若RFCA术前ATP试验诊断有DAVNP现象，术后ATP试验诊断无DAVNP现象意味着慢径阻断成功。

[Objective]To investigate the clinical value of adenosine triphosphate（ATP） on radiofrequeney catheter ablation（RFCA） of slowpathway of slow-fast type atrioventricular nodal reentrant tachycardia （AVNRT）. [Methods]The ATP which its initial dose was 0. 105mg/kg and used with the increment of a dose of 0.10 mg/kg for each time was injected to 40 patients through a femoral vein who had slow-fast AVNRT un- til the appearance of one of following signs such as dual atrioventricular nodal pathways （DAVNP）, second- or third-degree atrioventricular block, etc. Repeated doses of ATP were given to the patients who presented DAVNP by ATP test after successful slow pathway ablation. The surface and intracardiac electrocardiogram were recorded consecutively. [Results]DAVNP was observed in 29 cases （72.5%） before RFCA. The 29 pa- tients had no DAVNP by injecting repeated doses of ATP after successful slow pathway ablation. [Conclusion] ATP is a determining index of DAVNP. It shows that slow-pathway ablation is successful if a patient who has DAVNP before RFCA has not DAVNP after RFCA by ATP test.