高原地区56例阵发性室上性心动过速患者的电生理及消融特征

Electrophysiology and radiofrequency ablation characteristics of fifty-six patients with paroxysmal supraventricular tachycardia in high altitude areas

目的总结国内首批高原地区行射频消融治疗的室上性心动过速(简称室上速)患者的临床及电生理资料,探讨高原地区室上速的电生理特征及手术疗效。方法回顾确诊并行射频消融治疗的首批室上速患者,收集并分析所有患者的临床及电生理检查和射频消融手术资料。结果共收集56例,全部为世居海拔3 000m以上的高原藏族居民,其中男17例,女39例。室上速发作病史(9.26±10.28)年。房室结折返型心动过速(AVNRT)略多于房室折返型心动过速(AVRT)(57.14%和42.86%);男性患者中AVRT是AVNRT的2.4倍(70.6%与29.4%),女性患者中AVNRT是AVRT的2.3倍(69.3%与30.7%),差异有显著性(P=0.003)。AVRT初次发作室上速年龄小于AVNRT[(38.35±18.28)岁vs(47.45±13.97)岁,P=0.04]。AVRT心室刺激诱发成功率显著高于AVNRT(79.2%vs 18.8%,P=0.00),而AVNRT的心房刺激成功率显著高于AVRT(96.9%vs 37.5%,P=0.00);房室旁路与房室结双径路患者的基础AH间期无差异[(78.68±23.24)ms vs(72.06±14.26)ms,P=0.29],但两组患者的HV间期比较,有差异[(43.05±11.65)ms vs(51.54±8.55)ms,P=0.02]。所有患者均成功完成消融手术,无手术相关并发症,随访1~41个月,未见复发病例。结论高原地区室上速患者基础电生理特征无特殊,接受射频消融手术安全有效,应普及推广。

Objective To study the electrophysiology characteristics and radiofrequency ablation effects in patients with paroxysmal supraventricular tachycardia（PSVT） in high altitude areas in Tibet. Methods The first 56 pa- tients with PSVT and receiving radiofrequency ablation in our hospital during January 2013 to June 2016 were en- rolled in this study. All patients＇ clinical and electrophysiology and ablation information were analysed retrospective- ly, in order to assess their electrophysiology characteristics and radiofrequency ablation effects . Results All 56 patients were tibetains flying in high altitude areas above 3 000 m, age from 21-77 with 17 males and 39 females . The rate of atrioventricular nodal reentrant tachycardia（AVNRT） was mildly higher than bypass mediated atrioven- tricular reentrant tachycardia（AVRT） （ 57.14% and 42.86%,P〉0.05）. Men had a higher rate of AVRT（70.6% and 29.4 %）while women had a higher rate of AVNRT（69.3 % and 30.7 % ）, both showing a P value--0.03 . The ageof AVRT onset was younger than AVNRT E（38.35±18.280） vs （47.45±13.97）,P =0.041. ARVT was more likely induced successfully by ventricular stimula- ting than AVNRT（79.2% and 18.8%,P=0.00）, while AVNRT was more likely induced successfully by atrial stimulating than AVRT（96.9% and 37.5% ,P〈0.00 ） . There was no differences in basic AH interval between patients with atrioventricular accessory pathway and atrioventricular nodal dual pathway[_（78.68 ± 23.24）ms vs （72.06 ± 14.26） ms, P = 0.29], but for HV interval, the P value between patients with atrioventricular accessory pathway and atrioventricular nodal dual pathway was 0.02, suggesting statistical significance. All of the patients ac- complished radiofrequency ablation successfully without complications, and no recurrences during 1- 41 monthes follow up. Conclusion There are no obvious differences in electrophysiology characteristics for the patients in high altitude areas compared to the other plain areas,and radiofrequency ablation can also be effectively and safely for these patients.