房室双旁道的食管心脏电生理特征

Characteristics of atrioventricular dual accessory pathways in esophageal electrophysiological examination

目的探讨房室双旁道食管心脏电生理检查的特征性改变。方法对14例经射频导管消融术证实的房室双旁道的食管心脏电生理检查作回顾性分析。结果10例房室双旁道的电生理特征为:①心房起搏时显示两种不同的预激图形和/或特殊类型室性融合波群,经食管心房起搏有利于显现左侧旁道。②诱发出两种逆向型房室折返性心动过速,由两条旁道形成折返环路。③顺向型房室折返性心动过速时,出现两种不同的R-P-间期和P-波或房性融合波。④排除房室结双径路后,逆向型房室折返性心过速的频率快于顺向型房室折返性心动过速。⑤预激旁道的部位与顺向型房室折返性心动过速时P-波提示的部位不同。⑥双旁道隐匿性传导是造成其中一条旁道丧失传导功能的重要因素之一。另4例未能表现出上述电生理特征,其中右侧隐性旁道合并左侧隐匿性旁道1例,右侧隐匿性双旁道1例,左侧隐匿性双旁道2例。结论食管心脏电生理检查能够确诊大部分的房室双旁道,采用多导联同步记录及在房室折返性心动过速时仔细分析电生理表现有助于揭示房室双旁道。

Objective To investigate characteristics of atrioventricular dual accessory pathways (AP) in esophageal electrophysiological examination. Methods Characteristics of atrioventricular dual AP were observed by esophageal electrophysiogical examination in 14 patients. Atrioventricular dual AP was demonstrated by radiofreguency catheter ablation. Results Esophageal electrophysiological examination in 10 patients with atrioventricular dual AP showed follows:①There were two kind of pre-excitation waves and /or ventricular fusion wave in atrial pacing. Esophageal electrophysiological examination is more useful in showing up left atrioventricular AP.②Two kinds of retrograde atrioventricular reentrant tachycardia(AVRT) were deduced,reentry circles was formed by dual atrioventricular AP.③There were two kinds of R-P-period and P-wave or atrial fusion wave in anterior AVRT.④Excluding atrioventricular nodal(AVN) dual pathways,frequency of retrograde AVRT was higher than that of anterior AVRT.⑤Position suggested by retrograde P- wave in anterior AVRT did not coincide with position of pre-escitation pathway.⑥Concealed conduction between dual AP was one of improtant reasons why one of dual AP lost its conduction function. Above electrophysiologic characteristics were not showed in 4 patients with atrioventricular dual AP. Right concealed AP associated with left dual concealed AP 1 cases,right concealed AP 1 case ,left dual concealed AP 2 cases. Conclusion Most of atrioventricular dual AP can be definitely diagnosed by esophageal electrophysiological examination.Electrophysiological manifestation in AVRT and multiple-leads synchronous recording is helpful in diagnosis of atrioventricular dual AP.