显性预激射频消融后对房室结传导功能的影响

Effect of radiofrequency catheter ablation of manifestied pre-exciation on function of atrioventricular nodal conduction

目的分析显性预激射频消融前后PR间期的变化。方法收集2013年至2016年南京医科大学附属淮安第一医院行射频消融治疗的预激综合征患者120例,复发12例,检测患者消融前的心电图、超声心动图;消融后以及半年随访后心电图参数。结果患者依据旁路定位分为4组,另选健康对照1组。消融前,4预激综合征组超声心动图各腔室指标与健康对照组比较,差异无统计学意义(P>0.05);心电图的PR间期、QRS间期比较,差异有统计学意义(P<0.001、<0.001)。消融术后,4预激综合征组心电图心率、QRS间期、QTc间期与健康对照组比较,差异无统计学意义(P=0.704、0.353、0.534);5组PR间期的比较,差异有统计学意义(P<0.001),其中B型预激组最长,组间比较差异无统计学意义的A、B隐匿性组最短。消融术前,预激综合征复发患者心电图心率、QTc间期与初发患者比较,差异无统计学意义(P=0.310、0.234);而两者的PR间期、QRS间期比较,差异有统计学意义(P<0.001、<0.001)。消融术后,预激综合征复发患者心电图心率、QRS间期、QTc间期与初发患者比较,差异无统计学意义(P=0.939、0.855、0.895);而两者的PR间期比较,差异有统计学意义(P<0.001)。相关分析结果显示,显性预激消融术后△PR间期、△QRS间期呈正相关性(r=0.734,P<0.05)。结论房室旁路快速下传可干扰房室结的功能,这种影响与旁路定位有关,并且房室结的传导功能随着旁路传导功能消失可逐步恢复正常。

Objectives To analyze the changes of PR interval before and after radiofrequeney ablation of manifestied pre-exeiation. Methods Totally 120 patients with pre-exeitation syndrome treated by radiofrequeney ablation from 2013 to 2016 in Huaian First Hospital Affiliated to Nanjing Medical University were collected in this study, among them, 12 patients reemTed. Parameters of eleetroeardiography （ECG） and uhrasound eardiography （UCG） in these patients were compared before and after ablation, and parameters of ECG were compared after ablation and half a year follow-up. Results According to location of the pathways, patients were divided into 4 groups, and healthy peoples were selected as healthy control group. Before radiofrequeney ablation, parameters of UCG had no significant differences between 4 pre-exeitation syndrome groups and healthy control group （P 〉 0.05 ） ; and there were significant differences of PR interval and QRS interval of ECG among all the 5 groups （P 〈 0.001, P 〈 0.001 ）. After radiofrequeney ablation, there were no significant differences in heart rate （HR）, QRS and QTe interval （P = 0.704, 0.353, 0.534）among the 5 groups ; and there was a significant difference in PR interval （P 〈 0.001 ） among the 5 groups, the longest was in B type pre-exeitation group and the shortest were in concealed group A and group B. Before radiofrequeney ablation, recurrent patients with pre-exeitation syndrome had no significant differences in HR, QTe interval （P = 0.310, 0.234） , and had significant differences in PR and QRS interval （P 〈 0.001, 〈 0.001 ） compared to incipient patients. After radiofrequency ablation, there were no significant differences in HR, QRS interval, QTc interval （P = 0.939, 0.855, 0.895 ） , and there was significant difference in PR interval （P 〈 0.001 ）between recurrent patients with pre-excitation syndrome and incipient patients. Correlation analysis indicated that delta PR interval and delta QRS interval after radiofrequency catheter ablation of manifestied pre-exciation had positive correlation （r=0.734）. Conclutions Atrioventricular pathway rapid conduction can interfere function of the atrioventricular node. This effect is related to the location of the pathway, and the conduction function of the atrioventricular node can gradually restore to normal with disappearing of conduction function of atrioventricular pathway.