希氏束逆传不应期心室期前收缩刺激鉴别间隔部隐匿性房室旁道142例分析

His bundle conduction refractory period of ventricular premature stimulation in differential interval of concealed atrioventricular pathway:analysis of 142 cases

目的:探讨希氏束逆传不应期心室期前收缩刺激法鉴别间隔隐匿性房室旁道的应用要点。方法:74例慢-快型房室结折返性心动过速(AVNRT)和68例间隔部隐匿性快旁道引起的房室折返性心动过速(AVRT)患者,成功消融前常规行腔内电生理检查,同时行希氏束逆传不应期心室期前收缩刺激法。结果:心动过速时希氏束逆传不应期内心室期前收缩刺激,74例AVNRT患者心房激动无明显提前(变化<10ms),68例AVRT患者心房被提前激动超过20ms(30～50ms);此方法鉴别AVRT和AVNRT的敏感性与特异性均达100%。结论:心动过速时希氏束逆传不应期行心室期前收缩刺激法鉴别诊断AVRT和AVNRT的敏感性和特异性很高,且操作简单。但行此法检查时要求有持续发作的心动过速,能够标测出清晰的希氏束电位,心室期前收缩刺激最好与希氏束电位同步发放,反复多次重复检测可进一步提高诊断的准确性。

Objective：To investigate the value of ventrieular premature beat when His bundle is refractory during tachycardia in distinguishing atrioventricular septal fast pathway. Method：Seventy-four patients with slow-fast AVNRT and 68 patients with AVRT using concealed septal accessory pathway, underwent invasive electrophysiological studies and ventricular premature beat was induced when His bundle was refractory during tachycardia. Resuit ： When His bundle conduction refractory period within the ventricular premature beat stimulus during tachycardia, 74 cases with AVNRT were not obvious early atrial activation （variation was less than 10 ms）, in 68 cases with AVRT, the atrial premature excited more than 20 ms （30-50 ms）. The sensitivity and specificity of the method to identify AVRT and AVNRT were 100%. Conclusion： The sensitivity and specificity of the method to identify AVRT and AVNRT are quite high, and the operation is simple. But the inspection requires sustained tachycardia and a clear His bundle potential. Ventricular premature stimulus and His bundle electric potential should be synchronization, and repeated repetition detection could improve the accuracy of diagnosis.