食管心房调搏对房室传导功能的电生理研究

Electrophysiological studies on atrioventricular conduction function with transesophageal atrial pacing

目的通过食管心房调搏术测定房室传导系统的电生理参数来判断房室传导功能及其影响因素。方法以心动过缓测窦房结、房室传导功能和心动过速查因的患者124例为研究对象,行食管心房调搏检查。入选者均于术前行常规及动态心电图,停用抗心律失常药物5个半衰期。并对74例经食管心房调搏房室传导功能降低的患者,进行阿托品试验,试验前后对照分析。结果食管心房调搏对房室传导阻滞的检出率明显高于心电图及动态心电图。其中69例静推阿托品后显著改善,仅5例静推阿托品后无明显改善,而植入起搏器治疗。并有1例静注阿托品后诱发出房室结折返性心动过速。结论食管心房调搏可在早期发现并鉴别诊断功能性和病理性房室传导阻滞,具有重要的临床价值。

Objective To determine the atrioventricular conduction function and its influential factors by measuring electrophysiological parameters of atrioventricular conduction system with transesophageal atrial pacing （TEAP）. Methods One hundred and twenty-four patients were enrolled in the research and carried out inspection of TEAP. Among those patients, some underwent examination of functions of atrioventricular conduction and atrionector because of bradycardia while some were diagnosed with sychnosphygmia. All selected patients had taken routine and ambulatory electrocardiography before TEAP, with antiarrhythmic drugs withdrawn for 5 half-life periods. Seventy-four patients whose function of atrioventricular conduction had decreased after TEAP were enrolled in the atropine tests and made a contrast analysis before and after. Results The detection rate of atrioventricular conduction of TEAP was significantly higher than that inspected by routine and ambulatory electrocardiography. After intravenous injection of atropine, 69 cases improved significantly while 5 cases seemed no obvious improvement and switched to pacemaker implantation. Besides, atrioventricular nodal reentrant tachycardia was induced from 1 case after intravenous injection of atropine. Conclusion TEAP has important clinical value in early detection and differential diagnosis of functional or pathological atrioventricular block.