非典型跳跃房室结折返性心动过速的电生理学及射频消融治疗

Electrophysiological Characteristic and Ablation of"Atypical Jump"Atrioventricular Nodal Reentrant Tachycardia

目的 :观察部分电生理检查无典型跳跃现象的房室结折返性心动过速患者 ,探讨此组患者的电生理特点及射频消融手术的终点。方法 :比较患者慢径消融前后的文氏周期及房室结前传不应期的变化。结果 :消融前后前传房室结文氏周期[(295±34)msvs(330±48)ms]、房室结前传不应期[(258±24)msvs(294±32)ms)]均变化显著 (P<0 .01)。结论 :基础状态下快径路已经发生阻滞和快慢径的不应期相似是此类房室结功能曲线成连续性的可能原因 ,房室结前传不应期改变和异丙肾上腺素不能诱发均可作为慢径消融成功的指标 。

Objective:To study the electrophysiological characteristic of atypical jump atrioventricular nodal reentrant tachycardia and evaluate the endpoint of radiofrequency ablation.Methods:The Wenckebach period and refractory period were compared before and after slow pathway ablation.Results:The Wenckebach period and refractory period of atrioventricular nodal were significantly lengthened after ablation[(295±34)ms vs(330±48)ms,(258±24)ms vs(294±32)ms,respectively,P<0.01].Conclusion:Fast pathway block in basic condition and similarity of the refractory period between fast and slow pathway were the possible mechanism of continuous atrioventricular nodal function curve.Tachycardia cannot be induced after isoproterenol administra-tion,the change of refractory period was the end point of ablation,and the latter was more important.