慢快型房室结折返性心动过速的心动周期对经食管心房调搏诱发的指导价值

Guidance value of the cardiac cycle length of slow-fast atrioventricular nodal reentrant tachycardia in the induction of transesophageal atrial pacing

目的 探讨慢快型房室结折返性心动过速(S-F AVNRT)的心动周期(CCL)对经食管心房调搏诱发的指导价值。方法 入选2017年1月至2021年12月于武汉大学中南医院行经食管心房调搏术时诱发出320阵心动过速的191例患者心电图,进行回顾性研究。所有心动过速经心内电生理确诊为S-F AVNRT,探讨诱发S-F AVNRT时的S1S1刺激周期、S1S2脉冲联律间期与AVNRT的CCL的关系,并对不同范围的参数设置进行了诱发概率的分析。结果 320阵S-F AVNRT中有161阵通过S1S1刺激诱发,159阵由S1S2刺激诱发。S1S1刺激周期与AVNRT的CCL有明显的相关性(相关系数r=0.68>0.5,P<0.05);S1S2刺激的S2脉冲联律间期与AVNRT的CCL亦有明显的相关性(相关系数r=0.668>0.5,P<0.05)。S1S1刺激周期与AVNRT的CCL的差值S1-CCL符合正态分布:(-30.453±32.162) ms,P=0.745>0.05,当S1-CCL≤0时AVNRT的诱发累积概率为84.5%(146/161), S1周期小于CCL30ms左右时诱发率最高;S1S2刺激中的S2脉冲联律间期与AVNRT的CCL的差值S2-CCL也符合正态分布:(-38.509±39.055) ms,P=0.292>0.05,当S2-CCL≤0时AVNRT的诱发累计概率为84.3%(134/159),S2周期小于CCL30 ms左右时诱发率最高。结论 诱发S-F AVNRT所需的适时刺激周期、脉冲联律间期在很大程度由CCL所决定,大部分都需以小于心动过速周长的起搏周长或联律间期来诱发AVNRT,尤其在小于心动过速周长30 ms左右时反复刺激以诱发。

Objective To investigate the guidance value of cardiac cycle length(CCL) of slow-fast atrioventricular nodal reentrant tachycardia(S-F AVNRT) in the induction of transesophageal atrial pacing. Methods A retrospective analysis was performed on electrocardiogram of tachycardia diagnosed as S-F AVNRT by intracardiac electrophysiology in 191 patients induced by transesophageal atrial pacing in Zhongnan Hospital of Wuhan University from January 2017 to December 2021. The relationship between the stimulation cycle of S1S1and pulse interval of S1S2and the CCL of the AVNRT was explored. The induction probability of different parameter was analyzed. Results The 320 AVNRT were induced in 191 patients, among which 161 bursts were induced by S1S1stimulation and 159 bursts were induced by S1S2stimulation. S1S1stimulation cycle was positively correlated with the CCL of the AVNRT(correlation coefficient r=0.68>0.5, P<0.05), and the S2interval of S1S2stimulation was also positively correlated with the CCL of the AVNRT(correlation coefficient r=0.668>0.5, P<0.05). The difference between S1S1stimulation cycle and AVNRT′s CCL(S1-CCL) conforms to normal distribution:(-30.453±32.162) ms, P=0.745>0.05. When S1-CCL≤0, the cumulative induced rate of AVNRT was 84.5%(146/161), and when S1cycle was about 30 ms less than CCL, the induction rate was the highest. The difference between the S2interval of S1S2stimulation and the CCL of AVNRT also conforms to normal distribution:(-38.509±39.055) ms, P=0.292>0.05.When S2-CCL≤0,the cumulative induced probability of AVNRT was 84.3%(134/159), and when S2interval was about 30ms less than CCL,the induction rate was the highest. Conclusion The appropriate length of stimulation cycle and pulse interval are largely determined by CCL,which isusually less than CCL,and especially about 30ms less in length is the best.[Chinese Journal of Cardiac Pacing and Electrophysiology,2022,36(6):530-534]