食管心房调搏对预激综合征潜在危险性的评价

Evaluation of potential risk in preexcitation syndrome through transesophageal atrial pacing

为探讨评价预激综合征潜在危险性的方法,采用食管心房调搏检查32例显性预激综合征患者。结果显示程控刺激的起搏周长由≥600ms缩短至≤400ms时,旁道顺向有效不应期均值由287.19±31.85缩短至264.06±36.27ms,≤270ms的短旁道顺向有效不应期检出率由21.88％增至53.13％,旁道1:1下传最大心室率与起搏周长≥600ms及≤400ms的旁道顺向有效不应期均呈负相关(r分别为-0.68及-0.79);心房颤动时经旁道下传最短R-R间期与旁道1:1下传最大心室率呈负相关(r=-0.96),与起搏周长≥600ms及≤400ms的旁道顺向有效不应期呈正相关(r分别为0.79及0.93)。与早期心内电生理研究结果基本一致。认为食管心房调搏在很大程度上可替代心内电生理测定旁道顺向有效不应期(程控刺激的起搏周长至少包括≥600ms及≤400ms)、旁道1:1下传的最大心室率及心房颤动时心室反应来评价预激综合征潜在危险性。

In order to investigate approachs of potential risk in evaluating preexcitation syndrome, thirty-two patients with preexcitation syndrome were studied elec-trophysiologically by using technique of trans-esophageal atrial pacing (TEAP). Results show ante-grade effective refractory periods of accessory pathway ( AERPAP ) shortens from 287. 19 ± 31. 85ms to 264. 06±36. 27ms and rate of AERPAP≤270ms increase from 21. 88% to 53. 13% with shortening of paced cycle length of programmed stimulation shortened from≥600ms to≤400ms, maximum rate of 1: 1 A-V conduction over accessory pathway (AP) exhibited a negative relationship with AERPAP examined by paced cycle length of≥600ms ( r = - 0. 68 ) or ≤400ms ( r=-0. 79), and shortest R-R interval during atrial fibrillation (AF) induced by rapid atrial pacing related strongly with maximum rate of 1 : 1 A-V conduction over AP ( r =- 0. 96 ) and AERPAP examined by paced cycle length of≥ 600ms ( r = 0. 79) or≤ 400ms ( r = 0. 93). These results were consistent with those studied by previous endocavity eletrophysiologic technique. We think TEAP could substitute endocavity electrophysiology in a great degree to evaluae of potential risk in preexcitation syndrome, which can determine AERPAP by programmed stimulation at multiple cycle lengths including at least two cycle lengths of≥ 600ms and≤400ms, maximum rate of 1: 1 A-V conduction over AP by incremental pacing, and ventricular response when AF was induced by rapid atrial pacing.