不典型房室结折返性心动过速射频消融的疗效

Radiofrequency ablation treats atypical atrioventricular nodal reentrant tachycardia:a retrospective study of 21 cases

目的比较不典型房室结折返性心动过速(atrioventricular nodal reentrant tachycardia,AVNRT)与典型AVNRT在消融时交界性心律伴有室房传导阻滞发生率、消融成功率和复发率等方面有无差异,探讨不典型AVNRT射频消融的疗效。方法 21例AVNRT患者电生理检查结果为不典型AVNRT组(慢慢型14例,快慢型7例),选择同期检查年龄和性别与不典型AVNRT组相匹配的典型AVNRT21例作为对照。2组患者均采用消融慢径的方法 ,以消融过程中出现交界性心律,消融后室上速不再被诱发作为消融成功终点。比较2组患者交界性心律伴有室房传导阻滞发生率、手术时间、X线曝光时间、消融次数、成功率、并发症发生率和复发率有无差异。结果 2组患者术中诱发的室上性心动过速周长无差异(P>0.05);与典型AVNRT组相比,不典型AVNRT组室上速时H-A间期延长[(155.90±40.86)msvs(32.62±18.25)ms,P=0.01],A-H间期缩短[(142.76±78.46)msvs(265.29±43.67)ms,P=0.034]。所有患者达消融成功终点。2组患者的手术时间、X线曝光时间、消融次数、并发症发生率无差异(P>0.05)。典型和非典型AVNRT患者慢径消融过程中均出现交界性心率反应,不典型AVNRT组交界性心律伴有室房传导阻滞发生率显著高于典型AVNRT组(66.7%vs9.5%,P=0.02),但无继发的房室传导阻滞发生。2组患者消融术后均无房室传导阻滞等并发症发生。随访(25.3±11.6)个月,不典型AVNRT组阵发性室上速的复发率高于典型AVNRT组(23.81%vs4.76%,P<0.05)。结论不典型AVNRT慢径消融安全有效。与典型AVNRT慢径消融相比,不典型AVNRT有效消融时,常出现交界性心律伴室房传导阻滞发生,但不提示房室传导阻滞。不典型AVNRT消融术后复发率相对较高。

Objective To investigate whether radiofrequency （RF） ablation has same efficiency on treatment of atypical atrioventricular nodal reentrant tachycardia （AVNRT） as on that of typical AVNRT. Methods According to electrophysiological examination results,21 cases of atypical AVNRT （including 14 cases of slow/slow type and 7 cases of fast/slow type） were found among 248 identified AVNRT who underwent RF ablation from June 2006 to June 2009 in our department,and another 21 age- and gender-matched cases of typical AVNRT from this cohort served as control. The junctional rhythm appeared when slow pathway ablation was performed and successful RF ablation was achieved when the supraventricular tachycardia was no longer inducible. The rate of ventriculoatrial （VA） block of junctional rhythm during slow pathway ablation,numbers of ablation application,procedure time,X-ray exposure,complications,acute success rate and recurrent rate were compared between atypical and typical AVNRT. Results There was no obvious difference in the tachycardia cycle length between the 2 groups （P0.05）. The H-A interval during tachycardia in patients with atypical AVNRT was longer than that in control group （155.90±40.86 vs 32.62±18.25 ms,P=0.001）,but the A-H interval was shorter in the former than in the later （142.76±78.46 vs 265.29±43.67 ms,P=0.034）. All cases were successfully slow pathway ablated. There was no significance between the 2 groups in numbers of ablation application,procedure time,X-ray exposure,complications,and acute success rate. Compared to the control,the rate of VA block of junctional rhythm during slow passway ablation was higher （66.7% vs 9.5%,P=0.02）,but was not associated with the atrioventricular （AV） block. During the follow-up period of 25.3±11.6 months,the rate of recurrence in atypical AVNRT group was higher than that in control group （23.81% vs 4.76%,P0.05）. Conclusion Slow pathway ablation is effective and safe for atypical AVNRT as for typical AVNRT. Compared to typical AVNRT ablation,the rate of VA block of junctional rhythm during slow passway ablation is higher in atypical AVNRT,but has no relation to the AV block complication. The rate of recurrence after ablation might be a little higher.