室房间期差值对间隔部旁道与快径逆传心动过速的鉴别诊断价值

Diagnostic Value of the delta Ventriculoatrial Interval to Distinguish Retrograde Conduction of a Septal Accessory Pathway from a Fast Pathway Tachycardias

【目的】研究间隔部旁道参与的和房室结功能连续曲线性快径逆传的室上性心动过速的电生理特征 ,为射频治疗提供准确的定位依据。【方法】选择 10例间隔旁道介导的房室折返性心动过速 (AVRT ,旁道组 )与 10例房室结功能连续曲线的房室结折返性心动过速 (AVNRT ,房室结组 )病人 ,分别在与心动过速相同的频率起搏右心室及心动过速发作时 ,测量希氏束 (HBE)、冠状窦近端 (CS9-10 )导联记录的室房传导间期 (VAVP和VASVT)及两者差值ΔVA(VAVP-VASVT)。【结果】①房室结组心室起搏与心动过速时VA间期差异显著 (P <0 0 0 1) ,而旁道组差异无显著性 (P >0 0 5 ) ;②心室起搏时旁道组与房室结组的VAVP相比差异无显著性 (P >0 0 5 ) ;③心动过速时VA间期旁道组明显长于房室结组 ,两者相比VASVT差异显著 (P <0 0 0 1) ;④旁道组ΔVA与房室结组比较差异显著 (P≤ 0 0 0 1)。【结论】CS9-10 导联ΔVA是鉴别隐性间隔部旁道介导的AVRT与AVNRT的重要参考指标 ,特别对房室结功能连续曲线性房室结折返性心动过速的鉴别有较高价值。

Objective To study the electrophysiologic features of supraventricular tachycardia mediated by septal accessory pathway and by intranodal pathway, in order to decide the accurate location for radiofrequency therapy. Methods Ten patients with tachycardia mediated by septal accessory pathway (group AP) and 10 patients with atrioventricular nodal reentrant tachycardia (AVNRT) with the electrophysiological characteristic of continuous atrioventricular nodal function curve (group AVN) were paced with electrophysiological examination. Ventriculoatrial intervals and dalta ventriculoatrial intervals (ΔVA) were measured at the electrograms of the His bundle and proximal coronary sinus during tachycardia. Right ventricular apical pacing was done at the same rate as that of tachycardia. Results In group AVN, the VA interval during ventricular pacing was significantly different from that during tachycardia (P<0.001), but the difference in group AP was not statistically significant (P>0.05). The VA interval during tachycardia was significantly longer in group AP than in group AVN (P<0.001). There was significant difference of ΔVA between group AP and group AVN (P≤0.001). Conclusion ΔVA is an important index in the differential diagnosis between AVRT mediated by concealed septal accessory pathway and AVNRT, particularly for the AVNRT which has the electrophysiological characteristic of continuous atrioventricular nodal function curve.