三磷酸腺苷对房室结双径路的快径路前传和慢径路前传不同效应的临床研究

The clinical study of differential effect of adenosine-5′-triphosphate on antegrade fast pathway and antegrade slow pathway of dual atrioventricular nodal pathways

目的 :比较三磷酸腺苷 (ATP)对房室结双径路 (DAVNP)快径路前传 (AFP)和慢径路前传 (ASP)的抑制作用 ,并观察小剂量ATP能否诱发房室结折返性心动过速 (AVNRT)。方法 :经心内电生理研究 (EPS)证实为可诱发的慢快型房室结折返性心动过速 (SF AVNRT)患者 2 1例为ATP试验研究组 ,同期经EPS和射频导管电消融证实无DAVNP征象 ,且不能诱发AVNRT的患者 14例为对照组 ,在心房起搏下给予递增的ATP剂量。结果 :ATP试验显示 ,研究组患者 2 1例中 17例显示DAVNP电生理征象 ,其中 ,小剂量ATP诱发房室结回波 1例 ,AVNRT 3例 ,对照组无一例显示DAVNP电生理征象和诱发房室结回波或AVNRT。阻断AFP的ATP剂量明显小于阻断ASP的ATP剂量〔(5 .9± 1.6 )mg对 (11.9± 2 .2 )mg ,P <0 .0 1〕。结论 :AFP比ASP对ATP更敏感 ,提示AFP比ASP进入房室结的N区更广泛。对于部分SF AVNRT患者 。

Objective: To compare the suppressive effect of adenosin 5′ triphosphate (ATP) on antegrade fast pathway (AFP) and antegrade slow pathway (ASP) of dual atrioventricular nodal pathways (DAVNP), and observe whether low doses of ATP could be used to initiate atrioventricular nodal reentrant tachycardias (AVNRT).Method: Twenty one patients with inducible slow fast type AVNRT (SF AVNRT) were enrolled as study group, and 14 patients without the sign of DAVNP physiology and inducible AVNRT as control group. The incremental doses of ATP were given to them during atrial pacing.Result: The sign of DAVNP physiology was shown in 17 of 21 patients of study group by ATP test, among these 17 patients, AVN echo being induced in 1 patient and AVNRT in 3 other patients by lower doses of ATP. No sign of DAVNP physiology, ANV echo or AVNRT were found in patients of control group during the ATP test. The mean doses of ATP required to cause conduction block in AFP was significantly lower than that in the ASP [( 5.9 ± 1.6 )mg vs ( 11.9 ± 2.2 ) mg, P< 0.01 ].Conclusion: The AFP is more sensitive to ATP than the ASP, suggesting that the AFP enters into the N zone of AVN in a greater extent. The SF AVNRT can be initiated by lower doses of ATP in some patients.