房室旁道射频消融后T波改变的临床观察

The Clinical Assessment of T-wave Changes After Radiofrequency Ablation of an Accessory Pathway.

分析房室旁道射频消融术前后T波改变的影响因素 ,以揭示T波的改变机制。选择房室旁道患者 116例 ,其中显性旁道 82例、隐匿性旁道 34例。术中旁道均成功阻断 ,均为单支旁道 ,消融前后均无束支阻滞者。结果 :82例显性旁道患者有 79例 (96 % )有T波改变 ,而 34例隐性旁道患者无一例有T波改变 (P <0 .0 1) ;左、右显性旁道T波改变无显著性差异 (95 %vs 10 0 % ,P >0 .0 5 ) ;T波改变程度与预激程度有关 ;有T波改变和无T波改变患者消融时间 (116± 37vs 118± 5 2s)、能量 (2 7± 5vs 2 8± 7W)和消融后CK MB(2 0± 3vs 2 1± 5IU/L)差异无显著性 ,P均 >0 .0 5。结论 :射频消融术后T波改变由电张力调整所致 ,与心肌损伤无关。

The mechanism of T wave changes were identified by assessing facters causing T wave changes before and after radiofreqency ablation of accessory pathway.There are 116 patients with accessory pathway consisted of 82 of them were with manifest accessory pathway and 34 with concealed pathway.they all had single pathway and were ablated successfully,without bundle branch block before and after ablation.Results:79(96%) of 82 patients with a manifest pathway showed T wave changes.In contrast,none of 34 patients with a concealed pathway had T wave abnormalities after ablation( P <0.01).T changes had no significant difference between the left sided manifest accessory pathway and the right sided(95% vs 100%, P >0.05).The extent of T wave abnormalities after ablation correlated significantly with the degree preexcitation before ablation.The T wave changes did not correlate with the duration(116±37 vs 118±52 s, P >0.05) and energe of ablation(27±5 vs 28±7 W, P > 0.05 ) as well as CK MB(20±3 vs 21±5 IU/L, P >0.05).Conclusion:T wave changes after ablation are caused by 'Electrotonic modulation' and may not correlate with myocardal injury.