慢径消融治疗房室结折返性心动过速无交界性心律出现的电生理特点

Absence of junctional rhythm during successful slow-pathway ablation in patients with atrioventricular nodal reentrant tachycardia

目的 探讨射频消融房室结慢径时 ,治疗房室结折返性心动过速 (AVNRT)无交界性心律出现的电生理特点及其可能机制。方法 将 32 5例 A VNRT患者分为两组 :A组 30 4例 ,消融房室结慢径时出现交界性心律 ;B组 2 1例 ,消融慢径时无交界性心律出现。比较两组慢径消融时消融导管电极所在部位 ,A/ V比值 ,有无碎裂波或慢径电位 ,以及好发于何种 AVNRT。结果 B组多为快 -慢 (Fast- Slow) AVNRT患者 ;B组 A/ V>A组A/ V比值 ;B组患者消融导管电极大多位于后区 ,且较少记录到碎裂波或慢径电位。结论 消融慢径时 ,极少数病例无交界性心律出现 ,也可成功地打断房室结慢径使治疗 AVNRT获得成功。

Objective To assess the electrophysiological features and possible mechanism of successfully ablating the slow pathway while without any junctional rhythm occurred.Methods This study included 325 patients with AV nodal reentrant tachycardia who underwent catheter ablation of the slow pathway.AVNRT patients were divided into 2 groups.Group A(n=304):patients with junctional rhythm;Group B:patients without junctional rhythm.Location of ablation sites,atrial/ventricular electrogram amplitude ratio.multicomponent or slow pathway potential and occurrence of the form of tachycardia were compared in the 2 groups.Results The fast slow form of tachycardia was more common in group B;A/V electrogram amplitude ratios were significantly larger in group B than in group A;ablation sites were located mostly in the posterior area;a multicomponent or slow pathway potential was rarely seen in group B.Conclusion In some rare cases,successful slow pathway ablation is possible in the absence of a junctional rhythm.