心动过速发作时不同剂量的三磷酸腺苷对房室结快、慢径阻断作用的研究

Effects of Different Dosage of ATP on the Fast and Slow Pathway During the Episode of Atrioventricular Nodal Reentrant Tachycardia.

在心动过速发作时 ,观察不同剂量的三磷酸腺苷 (ATP)对房室结 (AVN)快、慢径的阻断作用 ,进一步探讨快、慢径的电生理特性。对符合诊断的 2 4例房室结双径且可诱发出房室结折返性心动过速 (AVNRT)的病人进行研究 ,用食管调搏或心内电生理检查方法重复诱发心动过速。静脉给予不同剂量ATP ,以 0 .0 5mg/kg为起始剂量 ,0 .0 2 5mg/kg为递增量 ,直至ATP用量达 0 .2 0mg/kg。在AVNRT发作时 ,观察不同剂量的ATP对同一病人房室结快、慢径的阻断情况。在 2 0例 (83.3% )的患者中 ,ATP终止AVNRT于前传慢径 ,其ATP用量为 0 .119± 0 .0 43mg/kg;在 3例(12 .5 % )的患者中 ,ATP终止AVNRT于逆传快径 ,其用量为 0 .175± 0 .0 2 9mg/kg;在 1例 (4 .2 % )的患者中 ,较小剂量ATP终止AVNRT于前传慢径 ,递增剂量则终止于逆传快径。结论

We studied the effects of different dosage of ATP on the fast and slow pathway during the episode of atrioventricular node (AVN) reentrant tachycardia (AVNRT) and further discussed electrophysiologic properties.This study included 24 patients with dual AVN pathways and AVNRT induced by program cardiac stimulating.Different dosage of ATP was administered intravenously.The initial dose of ATP (0.05 mg/kg) was followed by a stepwise increment of 0.025 mg/kg ATP given at 3 minute interval until a maximal dose 0.2 mg/kg was achieved,to see the block site at fast pathway or slow pathway.AVNRT in 20 patients (83.3%) was teminated at the antegrade slow pathway,the average dosage of ATP was 0.119±0.043 mg/kg.AVNRT in 3 patients (12.5%) was terminated at the retrograde fast pathway,the average dosage of ATP was 0.175±0.029 mg/kg.AVNRT in one patient (4.2%) was terminated at the slow pathway with smaller dose (0.15 mg/kg) and at the retrograde fast pathway with larger dosage (0.20 mg/kg).Conclusion:The antegrade slow pathway is more sensitive to ATP than the retrograde fast pathway block during the episode of atrioventricular node reentrant tachycardia.[Chinese Journal of Cardiac Pacing and Electrophysiology,2000,14(3):167～170]