引起逆向型房室折返性心动过速间隔部旁路的电生理特点

Electrophysiologic Characteristics of Paraseptal Accessory Pathway of Antidromic Reciprocating Tachycardia

目的 :探讨能够引起逆向型房室折返性心动过速间隔部旁路的电生理特点。方法 :通过比较能够引起逆向型房室折返性心动过速的间隔部旁路 (间隔部旁路组 )和非间隔部旁路 (非间隔部旁路组 )患者旁路前传和房室结逆传有效不应期及传导时间的不同 ,探悉能够引起逆向型房室折返性心动过速间隔部旁路的电生理特征。结果 :2 7例逆向型房室折返性心动过速患者中 ,间隔部旁路 6例 ,非间隔部旁路 2 1例。两组患者旁路前传有效不应期〔( 2 5 9± 3 3 )ms比 ( 2 66± 2 4)ms ,P >0 0 5〕、房室结逆传有效不应期〔( 2 62± 3 1)ms比 ( 2 71± 17)ms ,P >0 0 5〕和心动过速频率〔( 168± 3 1)次 /分比 ( 176± 2 5 )次 /分 ,P >0 0 5〕无显著性差异。与非间隔部旁路组患者相比 ,间隔部旁路组患者旁路前传时间〔( 76± 2 1)ms比 ( 3 9± 13 )ms ,P <0 0 1〕和房室结逆传时间〔( 10 3± 3 5 )ms比 ( 4 6± 19)ms ,P <0 0 1〕明显延长 ,均有极显著性差异。结论 :旁路顺传或房室结逆传速度减慢使间隔部旁路能够引起逆向型房室折返性心动过速。

Objective:To investigate the electrophysiologic characteristics of antidromic atrioventricular reciprocating tachycardia (A-AVRT) in patients with paraseptal accessory pathway(AP). Methods:In order to investigate the electrophysiologic characteristics of patients with A-AVRT utilizing a paraseptal AP as anterograde conduction limb,we compared the conduction time and refractoriness of the A-AVRT circuit between paraseptal AP group and nonparaseptal AP group. Results:Twenty-seven patients with induced A-AVRT were divided into 2 groups, paraseptal AP group(n=6)and non-paraseptal AP group(n=21). There were no significant differences in heart rate〔(168±31)bpm vs.(176±25)bpm,p>0.05〕,refractoriness of anterograde〔(259±33)ms vs.(266±24)ms,p>0.05〕and retrograde〔(262±31)ms vs.(271±17)ms,p>0.05〕components of the macroreentry circuit between the two groups. Anterograde conduction time through the AP〔(76±21)ms vs. (39±13)ms,p<0.01〕and retrograde atrioventricular nodal(AVN) conduction time〔(103±35)ms vs. (46±19)ms,p<0.01〕 were significantly longer in patients with paraseptal AP than those with nonparaseptal AP. Conclusion:A-AVRT can occur in patients with a paraseptal AP,because of slower anterograde AP conduction and retrograde AVN conduction.