房室结折返性心动过速的电生理特征和射频消融

The Eletrophysiologic Characteristics and Radiofrequency Catheter Ablation in Patients With Atrioventricular Nodal Reentrant Tachycardia

目的 观察房室结折返性心动过速 (AVNRT)的电生理特性 ,探讨AVNRT的消融方法学及疗效判断终点。方法 对 42例AVNRT患者进行射频消融治疗 ,测量术前快经路前传有效不应期 (FERP -B)、术后快经路前传有效不应期 (FERP -A)、术前和术后房室结前传文氏周期 (Wen -AVN)、心房程序刺激最长A2 H2 间期 (AHmax)、心动过速时A2 H2 间期 (AHsvT)及心动过速周长 (CL)。结果 42例AVNRT患者中 ,慢—快型 40例 ,慢—慢型 1例 ,快—慢型 1例。所有患者消融慢径路后均未诱发AVNRT ,成功率为 10 0 %。消融前后房室结前传文氏周期分别为3 2 9.14± 5 2 .3 4ms和 3 18.47± 46.2 5ms,差异无显著性 (P >0 .0 5 )。消融FERP -B和FERP -A分别为 :3 12 .14± 5 1.3 6ms和 2 67.62± 48.80ms,差异有非常显著性 (P <0 .0 1)。结论 彻底阻断慢径传导 ,可改善房室结传导功能 ,是RF CA治疗AVNRT安全、有效、理想的消融终点。

Objective: To observe the eletrophysiologic properties in patients with atrioventricular nodal reentrant tachycardia and investigate the methodology of radiofrequency catheter ablation and evaluate the effect of ablation endpoint. Methods: adiofrequency catheter ablation were performed in 42 patients with AVNRT. FERP-B and FERP-A, Wen AVN B and Wen AVN A,AHmax,AHsvt and CL were measured. Results:There were 40 cases slow slow form,one case slow fast form and one case slow slow form in in 42 patients with AVNRT.AVNTR could not be induced after the ablation of slow pathway in all patients,the total success rate was 100%. The Wen AVN of before and after ablation were 329.14±52.34ms and 318.47±46.25ms respetively,there is no significant difference(P>0.05). FERP-B and FERP-A were 312.14±51.36ms和267.62±48.80ms respetively,there is significant difference(P<0.01). Conclusion: Selective ablation of slow pathway might improve AVN conduction. It is also safe,effective and idea endpoint in the treatment of AVNRT with RFCA.