不同部位房室旁路电生理特点的临床研究

A study of electrophysiologic characteristics of different accessory pathways

目的探讨不同部位房室旁路的电生理特点。方法选择2007年4月至2010年4月共156例有房室旁路参与的顺向性房室折返性心动过速为研究对象。均行标准心内电生理检查，根据房室旁路位置的不同分为左侧游离壁组、间隔组、右侧游离壁组，分别测量各组的AH间期、旁路前传不应期、心动过速周长、房性心律失常发生率，采用SPSS16．0统计学软件进行分析。结果156例研究对象中，42例为左侧游离壁旁路，84例为间隔旁路，30例为右侧游离壁旁路，间隔部组的心动过逮平均周长显著短于右侧游离壁及左侧游离壁组[（308±6）msVS（327±28）ms，P〈0．01；（308±6）ms vs（360±13）ms，P〈0．01f。间隔旁路组心动过速时AH间期明显短于右侧游离壁组及左侧游离壁组[（74±6）msVS（122±5）ms，P〈0．01；（74±6）msVS（103．7±7）ms，P〈0．01]。左侧游离壁旁路患者的房性心律失常的发生率显著高于右侧游离壁旁路及间隔旁路的患者房性心律失常的发生率（42.8％VS0，P〈0．01；42．8％VS21．4％，P=0．002）。左侧游离壁旁路的前传不应期[（268±4）ms]也显著较右侧游离壁旁路的不应期[（312±72）ms]、间隔旁路不应期[（345±36）ms]短（P〈0．01）。结论间隔部旁路发生较快的顺向性心动过速，左侧游离壁旁路的房性心律失常的发生率高。

Objective In this study, the etectrophysiologic characteristics of different accessory pathways（APs） were investigated in detail to elucidate unique electrical properties of APs in each location. Methods From April 2007 to April 2010, a total of 156 patients with a AP - mediated tachycardia were enrolled in the study. A detailed examination electrophysiologic study was performed in all patients. according to the sites of APs, the patients were divided to 3 groups（ left free wall AP, septal AP, right free wall AP）. AH interval, antegrade effective refractory period, tachycardia cycle length, incidence of atrial arrhythmia. Statistics software 16.0 were used. Results A total of 156 patients,42 patients with left free wall APs,84 patients with septal APs and 30 patients with right free wall APs, were studied. The mean tachycardia cycle length was significantly shorter in patients with septal APs compared with those with right free wall and left free wall AP[ （308±6） ms vs（327 ±28） ms, P 〈0.01 ;（30 ±6） ms vs（360± 13） ms, P 〈 0.01 ]. The AH interval during tachycardia was shorter in patients with septal APs com- pared with those with right free wall and left free wall APs [ （74 ±6） ms vs（ 122±5） ms, P 〈0.01 ; （74±6） ms vs（104±7） ms, P 〈0.01 ]. The patients with left free wall AP had a significantly higher incidence of atrial arrhythmia （42.8%） than those with either right free wall （0%） or septal （28.5 % ） APs （ P = 0. 002 ）. The patients with left free wall APs also had a significantly shorter antegrade effective refractory period of the AP [ （268 ± 3.54） ms] than those with either right free ,vail [ （312 ±8） ms] or septal[ （345 ± 36） APs ] （ P 〈 0.01 ）. Conclusions septal APs are characterized by faster orthodromic tachycardia, whereas left free wall APs had a higher incidence of atrial arrhythmia.