经验性慢径改良治疗不能诱发但疑似为房室结折返性心动过速的长期随访研究

Long-term efficacy of empirical slow pathway modification in noninducible and suspected atrioventricular nodal reentry tachycardia

目的房室结折返性心动过速(AVNRT)患者心内电生理检查中不能诱发心动过速并不少见。经验性慢径改良可作为治疗不可诱发但疑似为AVNRT一种选择,但其长期疗效仍不清楚。方法对2005年1月至2013年12月经电生理检查证实或疑似为AVNRT并行慢径改良的患者进行回顾性随访。根据是否可诱发出与临床相同的室上性心动过速分为可诱发组(A组)和不可诱发组(B组)。对所有患者进行电话随访和/或临床随访。确定复发的依据为经再次手术证实和/或复发心电图和/或典型临床症状。结果一共纳入622例患者(平均年龄为46岁,女性56.8%)。A组488例,B组134例,B组中131例证实存在房室结双径路现象。中位随访时间31个月,总的因室上性心动过速的复发和因其他心律失常的复发分别为16例(2.6%)和32例(5.1%),其中A组和B组因室上性心动过速的复发率分别为2.9%和1.5%(P=0.560),其他心律失常复发率分别为4.5%和7.5%(P=0.170)。A组出现1例房室传导阻滞,B组无并发症。结论长期随访证实经验性慢径改良是治疗不可诱发但疑似为AVNRT一种安全有效的方案。

Objective The lack of reproduction of clinical paroxysmal supraventricular tachycardia （PSVT） by invasive electrophysiological study （EPS） is not uncommon in atrioventricular nodal reentrant tachycardia （AVNRT）. The long-term efficacy of empirical slow pathway modification for the treatment of noninducible and suspected AVNRT is not entirely clear. Methods From January 2005 through December 2013, all patients underwent slow pathway ablation were evalua- ted. Based on whether AVNRT could be induced, patients were divided into group A（AVNRT inducible） and group B （AVNRT noninducible）. Telephone communication, letter questionnaire and clinic visit were conducted for long-term follow up, Recurrence was based on symptoms and/or ECG documentation. Results Six hundred and twenty-two patients underwent slow pathway ablation （median age 46 years old, 56.8%female） were included in the study. 488 patients were divided into group A and 134 patients were divided into group B; in group B, double atrioventricular nodal pathway （DAVNP） was present in 131 patients. In a median follow up of 31 months, there were 16（2.6%） recurrence due to PS- VT and 32（5.1%） recurrence due to other arrhythmias. The recurrence rate due to PSVT was similar between group A and group B （2.9% vs 1.5% ,P=0. 560）, and the recurrence rate due to other arrhythmias was also similar between group A and group B （4.5% vs 7.5% ,P=0. 170）. I major complication atrioventricular block occurred in group A and no complication occurred in group B. Conclusions Empiricial slow pathway modification can be performed safely and effectively in noninducible and suspected AVNRT patients with good long-term results.