无创方法在预测预激综合征房室附加束前向不应期中的价值

VALUE OF NONINVASIVE METHODS IN PREDICTING ANTEGRADE EFFECTIVE REFRACTORY PERIOD OF ACCESSORY ATRIOVENTRICULAR(AV) PATHWAYS

预激综合征的房室附加束前向不应期是其伴发心房纤颤时心室反应快慢的决定因素。本研究将普鲁卡因酰胺,运动试验和Holter动态心电图监测等无创方法检查结果与食道调搏或有创电生理检查直接测得的房室附加束前向不应期加以对照,表明无创方法对于初步馅计附加束前向不应期有一定临床应用价值,安全、方便、易行,便于各级医院开展。

The antegrade effective refractory period of accessory AV pathways (AERP) is one of the main factors that may predict the rate of ventricular responses during atrial fibrillation in patients with preexcitation syndrome. This study compared the results of noninvasive methods including Holler monitoring and effects of intravenous procainamide and exercise testing on delta wave with those of direct measurement of AERP with invasive cardiac electrophysiologicai study (EPS). According to the measurement of AERP, the 17 cases we studied were divided into two groups: the first group consisted of Ⅱ cases with AERP of≤270 milliseconds and the second group 6 cases with AERP>270 milliseconds. In group I, delta waves disappeared after intravenous procainamide 10 mg/kg only in one patient out of 11, and in all the 6 cases of group Ⅱ, delta waves disappeared after administration with procainamide (P=0.001). During exercise test, delta waves disappeared in none of group Ⅰ but in 4 of group Ⅱ. During 24 hours Holler monitoring electrocardiographic morphology of venlricular preexci-tation was intennittenl in one out of 11 patients of group I and 5 out of 6 cases of group Ⅱ respectively. It is therefore suggested that the noninvasive methods could be used safely lo predict AERP of patients with preexcitation syndrome.