无跳跃现象的房室结折返性心动过速的电生理特点及射频消融

Electrophysiological features and radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia with"no-jumping" atrioventricular nodal functional curves

目的探讨无跳跃现象的房室结折返性心动过速(ANNRT)的电生理特点及射频消融终点。方法将75例行射频消融治疗的AVNRT患者分为三组:30例程序刺激无跳跃(A组);35例程序刺激有跳跃(B组);10例复发(C组)。比较三组射频消融前后电生理参数。结果与消融前相比,消融后A、B两组资料的房室结前传文氏周期(AVNWCL)均延长(P<0.01),保持稳定1∶1房室传导的最快心房起搏的PR/RR从大于1.0降为小于1.0(P<0.01);C组AVNWCL虽延长,PR/RR亦从大于1.0降为小于1.0,但两项参数的改变均无统计学意义(P>0.05);C组交界性逸搏总数明显少于A、B两组(P<0.01)。结论对于无跳跃现象的AVNRT射频消融后AVNWCL的显著延长,保持稳定1∶1房室传导的最快心房起搏的PR/RR从大于1.0降为小于1.0,以及消融过程中出现较多的交界性逸搏可作为判断射频消融终点的参考指标。

Aim To explore the electrophysiological features and endpoint of radiofrequency catheter ablation（RFCA） in atrioventricular nodal reentrant tachycardia（AVNRT） with＂no-jumping＂atrioventricular nodal function curves. Methods 75 patients with AVNRT were divided into three groups, group A （n = 30） ：patients with no AH jump in atrioventricular nodal function curves （AVNFC）, group B （n = 35） ; patients with a single AH jump in AVNFC,group C（ n = 10） ： patients who recurred AVNRT after RFCA. After ablation in the zone of slow pathway,electrophysiological parameters were compared with those before and after ablation among three groups. Results AV node Wenckebach cycle length（AVNWCL） were prolonged（ both P 〈 0.01 ）, and PR/RR during rapid atrial pacing at the maximum rate of sustained 1 ： 1 AV conduction decreased from more than 1.0 to less than 1.0 after ablation in group A and group B （ both P 〈 0.01 ）. Although AVNWCL was prolonged and PR/RR decreased from more than 1.0 to less than 1.0 in group C,there was no statistic significance（ P 〉 0.05 ）. In group C the total number of junctional ectopy was significantly less than that in group A and group B（P 〈 0.01 ）. Conclusions When performing radiofrequency catheter ablation in atrioventricular nodal reentrant tachycardia with ＂no-jumping＂ atrioventricular nodal function curves, a significant prolongation of AVNWCL, PR/RR during rapid atrial pacing at the maximum rate of sustained 1：1 AV conduction decreased from more than 1.0 to less than 1.0, and a much larger number of junctional ectopy can be regarded as an indicator of successful ablation.