室上性心动过速电生理检查中特殊现象分析

Analysis of Special Phenomenon During Electrophysiologic Study to Paroxysmal Supraventricular Tachycardia

目的分析阵发性室上性心动过速电生理检查中特殊现象。方法 3例中老年体表心电图显示阵发性室上性心动过速的患者,拟进行射频消融治疗,术前常规进行电生理检查,以明确其类型进而进行消融。结果 3例患者行心房基础及程控刺激,未见跳跃现象;心室基础及程控刺激,未发现存在隐匿性旁路;3例均未能诱发出室上性心动过速,静脉滴注盐酸异丙肾上腺素后,仍不能诱发出。在此电生理检查过程中,3例均诱发出阵发性心房纤颤,且在静脉滴注盐酸异丙肾上腺素后出现加速交界性心律。行窦房结恢复试验,1例显著延长。结论部分阵发性室上性心动过速的患者,电生理检查难以诱发,排除了房室旁路,考虑房室结双径路,且慢快径不应期接近,故难以诱发。此类患者容易诱发出房颤,不排除存在病态窦房结综合症的可能。

Objective To analyze special phenomenon during electrophysiologic study to paroxysmal supraventricular tachycardia （PSVT）. Methods Three cases＇ surface electrocardiogram showed paroxysmal supraventricular tachycardia by electrophysiologic study. Results They were given atrial stimulation, no jump phenomenon; they were given ventricular stimulation, no conceal accessory pathway. Three cases weren＇t induced PSVT, after intravenous drip isopropylarterenol hydrochloride, still wasn＇t induced. During electrophysiologic study, three cases were induced paroxysmal atrial fibrillation, after intravenous drip isopropylarterenol hydrochloride, they had atrioventricular junctional rhythm. By test of sinoatrial recovery time, one case showed remarkable lengthen of sinoatrial recovery time. Conclusion Partial cases of PSVT coundn＇t induce tachycardia. After excluding atrioventricula accessory pathway, dual A-V nodal pathways was cause of PSVT. They were easily induced paroxysmal atrial fibrillation, with possibility of sick sinus syndrome.