三磷酸腺苷在射频消融术中的临床应用研究

The clinical application of adenosine triphosphate in radiofrequency ablation

目的 探讨射频消融术中三磷酸腺苷（ＡＴＰ）对鉴别是否存在房室旁道的最佳剂量，以提高射频消融术的成功率，减少对多旁道病人的漏诊率。方法．通过对３７例具有逆向传导功能非房室旁路病例与４５例隐匿性房室旁路在心室起搏下分别应用 ＡＴＰ ０．２ｍｇ／ｋｇ、０． ２５ｍｇ／ｋｇ和 ０． ３ｍｇ／ｋｇ，观察 ＡＴＰ对房室结和旁道的作用，评价其在射频消融术中的应用价值。结果 ０．２５ｍｇ／ｋｇ的ＡＴＰ对评价旁道存在与否的敏感性为８３．７１％，特异性９７．７８％，阳性预测值９６．８８％，阴性预测值８８．００％，准确度９１．４６％。结论０．２５ｍｇ／ｋｇ的ＡＴＰ对鉴别同时存在房室结逆向传导的房室旁道有重要的指导价值，过大地增加剂量并不能提高诊断价值。

Objective The aim of this study is to investigate whether adenosine triphosphate (ATP) has the optimal dose to identify accessory pathway for elevating the successful rate of radiofreqency ablation and declining the oblivious diagnostic incidence in multiple accessory pathway during application of radiofreqency ablation. Methods 37 patients without accessory pathway who had retrograde conduction in atrioventricular node and 45 patients with concealed accessory pathway were respectively given adenosine triphosphate in 0. 2mg/ikg,0. 25mg/kg and 0. 3mg/kg to assess the value of application of ATP in radiofrequency ablation through observing the effects of ATP on atrioventricular node and accessory pathway during pacing at right ventricle. Results ATP in dose of 0. 25mgikg had the sensitivity of 83. 2%, the specificity of 97. 78%,positive predictive value of 96. 88%, negative predictive value of 88.00%, and accuracy of 91. 46% for testing whether accessory pathway existed. Conclusions ATP in dose of 0. 25mg/kg has an important significance to identify accessory pathway with retrograde conduction in atrioventricular node concurrently, it can not elevate the diagnostic value to increase the dose of ATP.