房室结慢径消融前房室阻滞的预测

Prediction of the risk of atrioventricular block before slow pathway ablation in atrioventricular node

目的 研究心脏电生理指标在普通型房室结折返性心动过速 (AVNRT)慢径消融前 ,预测消融后房室传导阻滞 (A BV)发生的可能性。方法 10 9例普通型AVNRT病人依消融过程中出现交界性心动过速 (JT)、无室房传导的JT及随后A VB发生与否分为 3组 :①无室房传导JT和随后A VB组 (组 1,16例次 ) ;②无室房传导JT而无A VB组 (组 2 ,2 6例次 ) ;③单纯JT组 (组 3 ,38例次 )。比较以下参数 :①His束A波至消融电极远端A波间期 [A(H) -A(Md) ] ;②His束A波至冠状窦口A波间期 [A(H) -A(CS) ] ;③消融靶点A V比值 ;④慢径电位 ;⑤碎裂心房波 ;⑥室房阻滞前JT周长。结果 组 1的A(H) -A(Md)间期明显短于组 2和组 3(16± 9.2msvs 34± 9.8ms ,30± 12 .4ms ,P <0 .0 5 ) ,而A(H) -A(CS)、A V比值、慢径电位、碎裂心房波及室房阻滞前JT周长与消融过程中是否发生A VB无关。结论 A(H) -A(Md)间期反映了消融电极头部与His为标记的房室结之间的距离 ,该间期越短 ,消融中发生A

Objective To determine whether te data of electrogram can be used to predict the risk of AV block before the employment of radio frequency (RF) energy to ablate the slow pathway in the mana gement of common AV nodal reentry tachycardia (AVNRT). Methods 109 patients with common AVNRT were divided into 3 groups according to the clinical conditions as follows: ①Group 1 (16 episodes) consisted of patients with VA block during junctional tachycardia (JT) and consequent AV block. ②Group 2 (26 episodes ) consisted of patients with VA block during JT and without consequent AV block. ③Group 3 (38 episodes) consisted of patients without both VA block during JT and consequent AV block. Electrograms before the application of RF were analyzed to determine the interval between the atrial signals in the His bundle catheter and in the distal mapping catheter [A(H) A(Md)], the interval between the atrial signals in the His bundle catheter and in the proximal coronary sinus catheter, [A(H)-A(CS)], the AV ratio, a slow pathway potential or a fractional atrial signal in the distal mapping catheter and the mean cycle length (CL) of JT before VA block. Results The A(H) A(Md) interval was significantly shorter in group 1 than in groups 2 and 3 (16±9.2 ms vs 34±9.8 ms and 30±12.4 ms, P <0.05) and showed no significant difference between groups 2 and 3. The A(H) A(CS) interval, AV ratio, slow pathway potential, a fractional atrial electrogram and CL of JT showed no relation to the occurrence of AV block confirmed with logistic regression analysis. Conclusion The A(H) A(MD) interval reflects the distance of the distal electrode of the mapping catheter to the region of the compact AV node marked with the His bundle catheter. The shorter the interval, the more possible the occurrence of AV block during RF delivery.