长快径不应期房室结双径路的临床特点与治疗(附2例报告)

The Clinical Features and Treatment of Dual Atrioventricular Nodal Pathway Effective Refractory Period(2 cases report)

目的 :探讨长快径有效不应期 (ERP)房室结双径路的产生机理、临床特点和治疗。方法 :报告 2例长快径ERP房室结双径路患者的临床症状、心电图表现及电生理特征。结果 :患者表现为长PR间期时出现心悸、胸闷、气促、颈静脉搏动 ,PR间期恢复正常时症状消失。基础状态下快径ERP延长 ,静滴异丙肾上腺素和静推阿托品后快径ERP明显缩短。 1例消融慢径后快径ERP缩短 ,无房室传导阻滞。结论 :长快径ERP可能是迷走神经张力过高所致。长、短PR间期与症状出现和消失的对应关系是其主要临床特征。

Objective:To explore the occurrence mechanism,clinical features and treatment of dual atrioventricular nodal pathways in patients with a long fast pathway effective rafractory period(ERP).Methods:The clinical symptoms,electrocardiogram and electrophysiological features of 2 patients with long fast pathway ERP were reported.Results:The symptoms such as palpitation,thoraco-depression,shortness breath and pulsation of the external jugular veins occurred during long PR interval while disappeared during short PR interval.The ERP of fast pathway was long at baseline condition whereas it was shortened during isoproterenol infusion and after atropine injection.Ablation of slow pathway was performed in one patient and no atrioventricular block occurred.Conclusions:It may be that long fast pathway ERP is caused by the tension of parasympathetic nerve raised.The corresponding correlation between long and short PR interval and the symptoms occurrence and disappearence is its main clinical characteristics.Implantation of dual chamber pacemaker and ablation of slow pathway are the effective treatment.