选择性慢径路消融前后心脏电生理变化

Change of electrophysiology before and after selective RF ablation of slow AV node pathway

目的 比较房室结折返性心动过速患者行选择性射频消融（RFCA）慢径路术前、术后心脏各部分腔内电生理改变.方法 对房室结折返性心动过速患者在选择性慢径路RFCA前、后分别进行腔内电生理检查.记录RFCA前、后希氏束电图（HIS）、心房有效不应期（A-ERP）、心室有效不应期（V-ERP）、房室前传文氏阻滞点（AVN-WKB）、室房逆传文氏阻滞点（VAN-WKB）、房室结前传有效不应期（AVN-ERP）和房室结逆传有效不应期（VAV-ERP）,将RFCA前、后心脏各部分电生理参数进行分析比较.结果 RFCA前、后HIS电图A-ERP、V-ERP、AVN-ERP及VAN-WKB差异均无统计学意义（P＞0.05）,AVN-WKB、VAN-ERP差异有统计学意义（P＜0.05）.结论 选择性RFCA慢径路对房室结双径路疗效肯定.在RFCA前、后（急性期）房室前传、逆传电生理均有一定改变.这与RFCA改变了房室结的部分结构,如大部分病例慢径路消失有关,不同消融部位对房室结传导电生理改变产生不同结果.

Objective To compare the difference of electrophysiology before and after selective radiofre- quency catheter ablation （RFCA） of slow AV node pathway. Methods During the procedure, the eleetruphysio- logic parameters before and after RFCA including bundle of HIS, atrial. ERP （A-ERP）, ventricular ERP （V-ERP）, AV node wenckebach （AVN-WKB）, VA node wenckebach （VAN-WKB）, AV node ERP （AVN- ERP） and VA node ERP （VAV-ERP） were recorded. Paired each of electrophysiologic parameters before and af- ter RFCA was analyzed. Results There were no significant difference in bundle of HIS, A-ERP, V-ERP, AVN-ERP and VAN-WKB before and after RFCA（P〉0.05）, but significant difference in AVN-WKB and VAV- ERP pro and post RFCA （P〈0.05）. Conclusion There are certain effects in AVNRT by selective RFCA of slow anode pathway. Study shows some changes of antegrade conduction and retrograde conduction in AV node pre and post RFCA during the procedure. One of possibility is some constructional changes of AV node post RFCA. The constructional changes of AV node depend on the position of RFCA.