无逆传旁路的预激综合征患者的临床及电生理特点

Clinical and electrophysiological characteristics of patients diagnosed as preexcitation syndrome without retrograde accessory pathway

目的探讨无逆传旁路的预激综合征患者的临床及电生理特征。方法 159例预激综合征患者均行心内电生理检查,结果提示为旁路逆向传导阻滞共13例(无逆传旁路组),旁路前传和逆传功能共146例(双向传导旁路组),均行导管射频消融术治疗。比较两组临床、电生理特征以及导管射频消融术的治疗效果。结果与双向传导旁路组比较,无逆传旁路组患者年龄更大,存在房颤、晕厥病史者比例更高(P<0.05),而两组心房有效不应期、旁路前传有效不应期、房室节前传及逆传有效不应期等心内电生理参数比较,差异无统计学意义(均P>0.05)。无逆传旁路组患者射频消融手术时间、射频消融术放电滴定时间、射线曝光时间均长于双向传导旁路组,术后并发症发生率、复发率高于双向传导旁路组(P<0.05)。结论与双向传导的预激综合征患者比较,无逆传旁路患者自发性房颤及晕厥为常见,且射频消融术后并发症发生率、复发率高。

Objective To explore the clinical and electrophysiological characteristics of patients diagnosed as preexcitation syndrome without retrograde accessory pathway. Methods Of 159 patients with preexcitation syndrome undergoing intracardiac electrophysiologic examination,13 were diagnosed as accessory pathways with retrograde conduction block（ non retrograde accessory pathway group） and 146 as accessory pathways with antegrade conduction and retrograde conduction（ accessory pathway with bidirectional conduction group）. Radiofrequency catheter ablation（ RFCA） was conducted in all patients. The clinical and electrophysiological characteristics,and the therapeutic efficacy of RFCA were compared between the two groups. Results The ages of patients were older and the proportions of the patients with atrial fibrillation history and syncope history were higher in the non retrograde accessory pathway group compared with accessory pathway with bidirectional conduction group（ P〈0. 05）. There were no statistical differences in the electrophysiological parameters including atrial effective refractory period,effective period of retrograde accessory pathway or effective refractory period of the retrograde and antegrade atrioventricular node between the two groups（ all P〉0. 05）. The operation duration,electric discharge and titration duration and exposure time of RFCA in the non retrograde accessory pathway group were longer than those in the accessory pathway with bidirectional conduction group（ P〈0. 05）. The incidence rate of postoperative complications and recurrence rate in the non retrograde accessory pathway group were higher than those in the accessory pathway with bidirectional conduction group（ P〈0. 05）. Conclusion For the patients diagnosed as preexcitation syndrome without retrograde accessory pathway,spontaneous atrial fibrillation and syncope are common,and the incidence rate of postoperative complications and recurrence rate are higher after RFCA.