希氏束不应期内心室早搏刺激鉴别隐匿性间隔房室旁道与慢-快型房室结折返性心动过速

His bundle refractory period of ventricular premature stimulation in distinguishing the concealed septal accessory pathway and slow-fast form atrioventricular node reentrant tachycardia

目的探讨使用希氏束不应期内心室早搏刺激鉴别隐匿性间隔房室旁道与慢-快型房室结折返性心动过速的方法及临床应用注意事项。方法选取80例慢-快型房室结折返性心动过速(AVNRT)和40例隐匿性间隔房室快旁道引发的房室折返性心动过速(AVRT)患者,常规行电生理检查术诱发室上性心动过速,后采用希氏束不应期内心室早搏刺激来鉴别隐匿性间隔房室旁道与慢-快型房室结折返性心动过速,最后行射频消融术治疗。结果室上性心动过速发作时采用希氏束不应期内心室早搏刺激的方法,80例慢-快型房室结折返性心动过速的患者心房激动无明显提前,而40例隐匿性间隔房室快旁道引发的房室折返性心动过速患者心房激动提前均超过10ms(20~43ms),最后行射频消融术成功。此方法鉴别AVNRT及AVRT的敏感性及特异性均达到100%。结论室上性心动过速发作时采用希氏束不应期内心室早搏刺激鉴别AVNRT及AVRT的敏感性及特异性均很高;但行此检查时需要有心动过速持续发作,反复多次检查可进一步提高诊断的准确性。

Objective To investigate the way and value of ventricular premature beat when His Bundle is refractory period during tachycardia in distinguishing atrioventricular concealed septal pathway and slow-fast form Atrioventricular Node Reentrant Tachycardia.Methods Eighty patients with slow-fast form AVNRT and forty patients with AVRT of concealed septal pathway,underwent regular electrophysiological studies to induce the tachycardia,ventricular premature stimulation when His Bundle refractory period is to distinguish the concealed septal accessory pathway and slow-fast form AVNRT,and then give the patients with Radiofrequency Ablation therapy.Results When His Bundle refractory period within the ventricular premature beat stimulus during tachycardia,80 patients with AVNRT were not obvious early atrial activation,but 40 patients with AVRT,the atrial premature excited more than 10ms(20-43ms).Finally the Radiofrequency Ablation therapy was successful.The sensitivity and specificity of the method to identify AVNRT and AVRT were 100%.Conclusion The sensitivity and specificity of this method during tachycardia to identify AVNRT and AVRT are quite high;but this method requires sustained tachycardia,and repeated repetition detection can improve the accuracy of diagnosis.