AVNRT慢径消融中出现中等频率交界性心动过速的临床意义

Clinical significance of medium frequency junctional rhythm during slow pathway catheter ablation for atrioventricular nodal reentrant tachycardia

目的:探讨射频消融房室结折返性心动过速(atroi-ventricular nodal reentrant tarchycardia,AVNRT)慢径时出现中等频率交界性心动过速的临床意义。方法:回顾分析62例2010年1月～2012年3月本院成功消融AVNRT患者临床资料。其中男性22例,女性40例,年龄16～68岁。按消融过程中出现的结区反应特点分为A组[消融中出现持续中等频率交界性心动过速(100～140 bpm)]和B组(消融中出现间断性交界区心律即窦性心律与交界心律交替出现)。并比较两组手术成功率、AV逆传阻滞现象、放电次数、放电部位数、累积放电时间及术后复发情况。结果:所有病例均手术成功,24例(39%)术中出现中等频率的交界性心动过速,其中2例一过性室房逆传阻止(VAB),术中平均放电时间(112.1±21.2)s、放电次数2.6±2.4、放电部位2.4±2.0,术后无1例复发。38例(61%)手术中出现间断性交界区心律,其中1例一过性VAB,术中平均放电时间(149.2±26.7)s、放电次数5.2±3.4、放电部位3.0±.2.2,1例首次消融后复发。与B组比较,A组患者累积放电时间、次数均少于后者;手术成功率、放电部位、AVB、VAB发生率两组间无差异。结论:在AVNRT慢径消融过程中出现中等频率交界性心动过速为安全且有效的靶点标志。

Objective：To investigate the clinical significance of the medium frequency junctional rhythm（JR） occurring during slow pathway catheter ablation for atrioventricular nodal reentrant tachycardia （AVNRT）. Methods：The clinical data were reviewed in 62 patients （22 male,40 female） aged from 16 to 69 years with AVNRT undergone radiofrequeney ablation between Jan. 2010 and Mar. 2012. The total patients were allocated to group A（ n = 24 ,with continuous medium frequency JR during slow pathway catheter ablation） and group B（ n = 38 ,JR alternated with sinus rhythm during slow pathway ablation）on the characteristics basis of JR. Two groups were compared regarding the successful rate of ablation, occurrence of AV block, discharge times and sites, cumulative time of discharge and post-operative relapses. Results ： All patients were successfully managed with accelerated junctional rhythm（ A JR）. Alternated intra-operative tachycardia of medium frequency occurred in 24 in group A（39% ） in whom ventriculoatrial block （ VAB ） occurred in 2. The average discharge time was （ 112.1 ± 21.2） s in procedure ; the ablation time,2.6 ± 2.4; and the ablation sites, 3.0 ±. 2.2. No relapse occurred after the procedure. Intermit junctional rhythm occurred in the 38 patients （61% ） in group B,in which 1 was associated with VAB. The discharge duration was （ 149.2 ± 26.7 ） s on average ; the ablation times ,5.2 ± 3.4 ; and the ablation sites,3.02 ±. 2.2. Relapse occurred in one case after primary ablation. Although the ablation duration and frequencies were fewer as compared with group B, yet the successful rate, ablation sites required, and occurrence of AVB and VAB remained similarly for the two groups. Conclusion：Occurrence of medium frequency junctional rhythm during slow pathway catheter ablation may be marker of success for AVNRT.