三磷酸腺苷对房室结前向传导的影响与房室结前传功能的相关性研究

The effects of adenosine triphosphate on atrioventricular node antegrade conduction and their relationship

目的 评价三磷酸腺苷 (ATP)对房室结前向传导的影响与房室结前传功能的相关性。方法 选择 19例预激综合征行射频消融术后且房室结前传文氏点等于或大于 15 0次/分的患者 ,测量房室结前传功能 (前传文氏点、2 :1点)和有效不应期 ,在心房起搏时静脉推注ATP,直至 0 .3 0mg/kg或出现房室前传阻断。结果 房室结前传文氏点平均为 (3 0 5 .79± 4 5 .0 1)ms,前传 2 :1点平均为(2 62 .63±2 4 .5 5 )ms,房室结前传有效不应期平均为(2 3 5 .78± 5 9.2 4 )ms,阻断房室结前传所需ATP平均剂量为(0 .16±0 .0 5 7)mg/kg,总量平均为 (11.4±4 .5 3 )mg。房室结前传文氏点、2 :1点 (ms)与阻断其前向传导所需ATP剂量呈负相关 (r=- 0 .797,P <0 .0 1;r=- 0 .699,P <0 .0 1)。房室结前传有效不应期与阻断其传导所需ATP剂量呈负相关(r=- 0 .4 65 ,P <0 .0 5 )。结论 阻断房室结前向传导所需ATP与房室结前传功能、房室结前传有效不应期有明显相关性 ,房室结前传功能越好 ,房室结前传有效不应期越短 ,阻断房室结前传所需ATP剂量越大。

Objective To evaluate the effects of adenosine triphosphate (ATP) on the antegrade conduction of atrioventricular node (AVN) and their relationship. Methods Nineteen patients with preexcitation syndrome were involved who had received radiofrequency catheter ablation (RFCA) and whose antegrade Wenckebach point of the AVN were above 150 beats per minute. Each had the followings measured: the antegrade Wenckebach point and 2:1 conduction point and the effective refractory period (ERP). Adenosine triphosphate was given intravenously at the time of atrium pacing until the dose of ATP reaches 0.30 mg/kg or the antegrade conduction of the AVN was blocked. Results The mean antegrade Wenckebach point of the AVN was 305.63±45.01 ms, the 2:1 antegrade conduction point was 262.63±24.55 ms and the mean antegrade ERP of the AVN was 235.78± 59.24 ms. The average dose of ATP needed to block the antegrade conduction of the AVN was 0.16± 0.057 mg/kg, totaling 11.4±4.53 mg. The antegrade Wenckebach point and 2:1 point of the AVN were negatively related to the dose of ATP needed to block the antegrade conduction of the AVN ( r = -0.797 , P <0.01; r =-0.699, P <0.01). The same was the antegrade ERP and the dose of ATP needed to block the antegrade conduction of the AVN ( r =-0.455, P <0.05). Conclusion The dose of ATP needed to block the antegrade conduction of the AVN was obviously related to the antegrade and the antegrade ERP of the AVN. That is, the better the antegrade conduction and the shorter the antegrade ERP of the AVN, the larger the dose of ATP needed to block its antegrade conduction.