程序刺激不能诱发的房室结折返性心动过速行经验性慢径改良的临床疗效观察

Clinical observation of atrioventricular nodal reentrant tachycardia but without inducible tachycardia undergoing empirical slow pathway modification

目的:观察程序刺激不能诱发的房室结折返性心动过速射频消融行经验性慢径改良的临床疗效。方法:96例有心动过速病史且心电图疑断为房室结折返性心动过速(AVNRT)的病人,电生理检查排除AVRT,96例患者中62例患者(A组)有房室结双径并诱发AVNRT,30例患者(B组)有房室结双径但不能诱发心动过速,另有4例患者(C组)术中既无房室结双径亦不能诱发心动过速。对A组患者射频消融改良慢径,消融终点为阻断慢径或若慢径难以阻断则以不能诱发心动过速为终点;B组患者则以阻断慢径为消融终点:C组结合其发作时ECG疑诊为AVNRT患者亦经验性给予消融慢径,出现交界性心律与窦性心律交替现象,持续放电60ms即终止。术后随访。结果:96例患者均完成随访,A组随访时间(23.1±15.6)个月,仅1例在术后6个月复发(1.6%),经再次消融后随访8个月未再发;B组随访时间(20.2±13.4)个月,有2例分别在术后3个月及12个月复发(6.7%),经再次消融后现随访5个月及以上未再发;C组随访时间(11.2±1.6)个月,现已有3例在术后3个月后复发(75%)。其中B组和A组相比,复发率无统计学差异(P>0.05),而C组复发率明显高于A组或B组(P<0.01),有统计学差异。结论:有阵发性心动过速病史且发作时心电图疑诊为AVNRT患者,电生理检查有房室结双径路但未能诱发心动过速者,射频消融行经验性慢径改良具有良好的临床疗效,但对于电生理检查无房室结双径路亦未能诱发心动过速者,射频消融行经验性慢径改良的临床疗效则不确切。

Objective： To observe the clinical efficacy of atrioventricular nodal reentrant tachycardia undergoing empirical slow pathway modification by radiofrequency ablation, which could not be induced by programmed stimulation.Methods： 96 patients who had tachycardia history and were diagnosed by electrocardiogram as suspecting atrioventricular nodal reentrant tachycardia （AVNRT） were enrolled. The cases with atrioventricular reentrant tachycardia（AVRT） were excluded by electrophysiological studies. In 96 cases, 62 cases （group A ） had dual atrioventricular nodal pathways and could be induced atrioventricular nodal reentrant tachycardia（AVNRT）. 30 cases （group B ）bad dual atrioventricular nodal pathways, but could not be induced atrioventricular nodal reentrant tachycardia. While the rest 4 cases （group C） neither had dual atrioventricular nodal pathways, and also could not be induced tachycardia. Patients in group A were undergone slow pathway modification by radiofrequency ablation, ablation end point was blocking slow pathway. While if the slow pathway was difficult to block, set the point that tachycardia could not be induced as the ablation end point. In group B, ablation end point was blocking slow pathway. In group C, combining ECG when tachycardia onset, patients who were suspected to have AVNRT were also undergone empirical slow pathway ablation. When junctional rhythm and sinus rhythm alternating, continued discharging 60 milliseconds, then terminated. Followed up these 96 cases postoperatively. Results.. All the 96 patients completed follow-up. The patients in group A were followed up for （23.1±15.6） months, only 1 patient relapsed in the sixth month afier surgery（1.6%）. When the patient accepted ablation again, there was no recurrence in the subsequent 8 months. The patients in group B were followed up for （20.2±13.4） months, 1 patient relapsed in the third month after surgery and the other relapsed in the twelfth month（6.7%）. When these two patients accepted ablation again, there were no recurrence in the subsequent 5 months and after. The patients in group C were followed up for （11.2±1.6） months, now three cases have recurrence after 3 months postoperatively（75%）. Compared group B with group A, there was no significant difference in recurrence rate（P〉0.05）, while the recurrence rate in group C was significantly higher than that in group A or group B（P〈0.01）.Conclusiom Empirical slow pathway modification by radiofrequency ablation had good clinical efficacy in patients who had paroxysmal tachycardia history and were suspected to have AVNRT combining ECG when tachycardia onset, and also had dual atrioventricular nodal pathways, but could not be induced tachycardia by electrophysiological studies. While empirical slow pathway modification by radiofrequency ablation had inaccurate clinical efficacy in patients who neither had dual atrioventricular nodal pathways, and also could not be induced tachycardia by electrophysiological studies.