起源于冠状静脉窦口的右侧旁路合并房室结双径路的诊断与鉴别

Distinguishing and diagnosis of right atrioventricular accessory pathway originating from the coronary sinus ostium from atrioventricular nodal reentrant tachycardia

目的探讨复杂多径路心动过速时的应用拖带和程序S2刺激进行诊断和鉴别分析。方法回顾性分析1例间歇性预激波患者频发室上性心动过速,经心脏电生理检查行右心室拖带刺激和心室程序S2刺激,测量最后一跳刺激信号到自身心房波间期减去心动过速下心室到心房的间期(SA-VA)和起搏后间期(PPI)-心动过速周长(TCC),并行常规射频导管消融术治疗。结果术中心室分级刺激S1S1:350 ms诱发右侧旁路参与的房室折返性心动过速,TCL为372 ms,PPI为395 ms,继续行心房S1S2:500/310 ms刺激,"跳跃"诱发同前一样的室房波不融合心动过速。再次行心房S1S1:280 ms刺激,可反复诱发慢快型房室结折返性心动过速。在旁路参与的心动过速下给予心室程序S2刺激,测量PPI为385.1 ms,TCL为360.1 ms,PPI-TCL≤20 ms,证实为右侧旁路参与的房室折返性心动过速,同时存在慢快型房室结折返性行心动过速,给予常规射频导管消融成功径路和旁路。术后随访12个月未有心动过速发作。结论通过右心室心室拖带刺激,以及测量SA-VA间期和PPI-TCL间期可以用来鉴别典型房室结折返性心动过速与间隔房室旁路。

Objective To investigate the distinguishing and diagnosis of the complex accessory pathway by the entrainment and RS2.Methods One patient with intermittent Wolff-Parkinson-White syndrome was undergone electrophysiologic study.The entrainment and RS2 were performed on right ventricular apex,and the stimulation-Atrium minus Ventricular-Atrium (SA-VA ) and Post Pacing Interval minus Tachycardia Cycle Length (PPI-TCL)were measured.The conventional ablation was performed.Results The TCL was 372 ms,the PPI was 395 ms,the tachycardia was induced by classfication:fractional stimulation was demonstrated with ventricular S1 S1 :350 ms and programmed stimulation was demonstrated with atrium S1 S2:500 /310 ms.Atrioventricular nodal reentrant tachycardia was induced by atrium S1 S1 :280 ms.The programmed S2 stimulation was performed with the tachycardia of accessory pathway.The PPI was 385.1 ms and the TCL was 360.1 ms,PPI-TCL <20 ms.The tachycardia was confirmed for atrioventricular nodal reentrant tachycardia and interval atrioventricular accessory pathway.The forward pass was the slow conduction and the retrograde was right atrioventricular accessory pathway.Conclusion The SV-VA interval and PPI-TCL are useful in distinguishing and diagnosis with atrioventricular nodal reentrant tachycardia form atrioventricular accessory pathway by entrainment.