HV间期在判断房室传导阻滞预后和治疗中的临床意义

Clinical significance of HV intervals in assessing the prognosis and treatment of atrioventricular block

目的:通过电生理检查(electrophysiological study, EPS)记录希氏束至心室(His bundle-ventricular, HV)间期,识别房室传导阻滞(atrioventricular block, AVB)的阻滞水平及程度,判断病情预后及决定治疗策略。方法:Ⅰ~Ⅲ度AVB及束支传导阻滞17例患者,EPS确认阻滞水平位于房室结(atrioventricular node, AVN)或房室结下(结下),并按HV间期进行分组:≥70 ms为一组,>55~<70 ms为二组,≤55 ms为三组;结合临床症状及病情进展评估HV间期与治疗的相关性。结果:一组结下阻滞4例予永久起搏器(permanent pacemaker, PPM)治疗;二组HV间期延长伴临床症状3例予PPM治疗,无症状4例予随访;三组AVN阻滞2例及结下阻滞1例予PPM治疗,阻滞在AVN的无症状Ⅲ度AVB 3例予随访。结论:HV间期可确定AVB的阻滞水平及程度,结下阻滞多进展为高度AVB且需PPM治疗。

Objective:To observe the prognosis and treatment strategy of atrioventricular block(AVB)after recording the(His bundle-ventricular,HV)intervals by electrophysiological study(EPS)combined with identifying the level and degree of atrioventricular block(AVB).Methods:Seventeen patients were diagnosed asⅠ°toⅢ°AVB and bundle branch blocks.The block level of atrioventricular node(AVN)or infra-node was confirmed by EPS.The patients were divided into three groups according to HV intervals:≥70 ms(GroupⅠ),>55~<70 ms(GroupⅡ),and≤55 ms(GroupⅢ).The relationship between HV intervals and consecutive treatments combined with clinical symptoms and progresswere sought to discovered.Results:GroupⅠwith four patients all had infra-node block and underwent permanent pacemaker(PPM)therapy.GroupⅡhad seven patients.Three symptomatic patients with prolonged HV intervals underwent PPM therapy.The other four asymptomatic patients were followed up.GroupⅢhad sixpatients.Two had AVN block and one had infra-node block.These patients underwent PPM therapy in GroupⅢ.Three asymptomaticⅢ°AVB patients had block in AVN and were followed up.Conclusion:The HV intervals can help determine the level and degree of AVB.The infra-node block patients usually aggravate to high degree AVB and will thereafter need PPM therapy.