希氏束旁起搏鉴别间隔部隐匿性房室快旁道的临床价值

Value of Para-Hisian Pacing in distinguishing atrioventricular septal fast pathway

目的:探讨希氏束旁起搏鉴别间隔部隐匿性房室快旁道的临床价值。方法:采用希氏束逆传不应期心室期前收缩刺激法,将142例患者诊断为慢-快型房室结折返性心动过速(AVNRT)74例和间隔部隐匿性房室折返性心动过速(AVRT)68例。对142例患者采用希氏束旁起搏方法进一步检测。结果:希氏束旁刺激法检测结果显示,74例AVNRT患者中8例未检测成功,其余66例均为逆传房室结图形;68例AVRT患者中6例未检测成功,其余62例患者中48例均呈逆传旁道/旁道图形,14例呈非逆传旁道/旁道图形。如果以逆传旁道/旁道图形为标准鉴别间隔部快旁道引起的AVRT与慢-快型AVNRT,敏感性为77%,特异性为100%。结论:希氏束旁刺激法对间隔部隐匿性房室快旁道的鉴别诊断有很高的特异性。

Objective：To investigate the value of Para-Hisian Pacing in distinguishing atrioventricular septal fast pathway. Method.. A totle of 142 patients were devided into 74 patients with slow-fast AVNRT and 68 patients with AVRT using concealed septal accessory pathway by ventricular extrastimuli during tachycardia and His bundle refractory. Then, all the 142 patients underwent Para-Hisian Pacing. Result： During Para-Hisian Pacing, 66 AVNRT showed retrograde atrial activation only from atrioventricular node （retrograde from atrioventricular node map）. Fouty-eight AVRT （septal pathway） showed retrograde atrial activation only from pathway （retrograde pathway/pathway map） and 14 AVRT （septal pathway） displayed non-retrograde pathway/pathway map. Para- Hisian Pacing was performed unsuccessfully in 8 AVNRT and 6 AVRT patients with septal concealed pathway. Para-Hisian Pacing （retrograde pathway/pathway map as distinguishing standard） could distinguish AVRT using concealed septal fast pathway from slow-fast AVNRT, with 77% in sensitivity and 100% in specificity. Conclusion：Para-Hisian Pacing can diagnose and distinguish septal pathway with high specificity.