87例房室结折返性心动过速慢径消融电生理变化及终点探讨

Observation of Electrophysiological Change and the Endpoint of Radiofrequency Ablation in 87 Patient Suffering From Atrioventricula

目的探讨87例房室结折返性心动过速(AVNRT)患者射频导管消融(RFCA)慢径前后电生理变化及消融终点。方法根据房室传导系统对常规心房刺激反应的不同,将研究对象分为三组:各种心房程序刺激(S1S2和S1S2S3)均呈连续性房室结功能曲线(AVNFC)为A组,共15例;心房S1S2程序刺激呈连续性而S1S2S3程序刺激呈不连续性AVNFC为B组,共17例;心房S1S2(或伴S1S2S3)程序刺激呈不连续性AVNFC为C组,共55例。比较三组患者射频消融慢径前后电生理参数。结果A组和B组消融前后房室结前传ERP无明显变化;C组消融前后房室结前传ERP缩短(P<0.01)。消融后A、B组最长A2H2间期(A2H2max)虽无显著性差异(P>0.05),但均比消融前缩短;而C组显著缩短(P<0.01)。消融后A、B及C组中的6例最长A3H3间期(A3H3max)均比消融前显著缩短(P<0.01)。结论(1)增加心房S1S2S3程序刺激可提高AVNRT的诱发率;(2)消融后AHmax的变化为进一步探讨一种新的AVNRT消融成功指标提供了有价值的线索;(3)对于AVNCF不连续的病例,射频消融后房室结前传ERP的显著缩短可作为消融成功终点预测指标的有力依据之一;(4)消融术中不要一味追求慢径消失,否则有可能增加房室传导阻滞的发生。

Objective To observe the electrophysiological change and the endpoint of radiofrequency ablation in 87 patients suffering from atrioventricular nodal reentrant tachycardia (AVNRT). Methods 87 patients suffering from AVNRT were divided into 3 groups. Group A was 15 cases which included patients with continuous atrioventricular node function curves (AVNFC) during the single and the double atrial programmed stimulation (S1S2,S1S2S3) (n=15),group B was 17 cases which included patients with continuous AVN function curves during the S1S2 atrial programmed stimulation but discontinuous AVN function curves during the S1S2S3 atrial programmed stimulation (n=17),and group C was 55 cases whch included patients with discontinuous AVN function curves during the S1S2 (or the S1S2 and the S1S2S3) atrial programmed stimulation (n=55). Electrophysiological parameters of the all patitens were compared with before and after ablation of slow pathways in three groups.Results The anterograde AVN effective refractory period (ERP) remained unchanged after ablation in group A and B,but was shortened in group C (P<0.01). A2H2max was shortened in group A and B after ablation,but there were no statistics significance (P>0.05). In group C,A2H2max was shortened remarkably after ablation (P<0.01). A3H3max were shortened in all groups (P<0.01). Conclusion S1S2S3 programmed stimulation can improve the induced rate in most AVNRT patients;Significant changes of AHmax after ablation may provide valuable clues for the further explore a new AVNRT ablation success indicator;For those patients with discontinuous AVNFC,significant shortening of ERPAVN after ablation may be a strong basis in further explore the endpoint of radiofrequent ablation;Ablation should not blindly pursue in the slow pathway disappear,otherwise it may increase atrioventricular block.