房室旁路不彻底消融后电生理特性的改变

The changes of electrophysiological characteristics in atrioventricular accessory pathways induced by incomplete ablation

目的 分析探讨因射频消融术治疗使普通房室旁路蜕变为慢旁路并使患者具有持续性交界区反复性心动过速特征的现象。方法 对 6例相关患者心动过速发作的特点、慢旁路产生的原因、递减传导功能及靶点图特征等进行分析。结果 6例慢旁路均由普通房室旁路经不彻底的消融而致 ,具备递减传导、靶点VA不融合等特征。结论 除先天性房室慢旁路外 ,临床还存在继发于不彻底的射频消融术的慢旁路。因此 ,建议根据病因不同 ,将慢旁路分为先天性和获得性两种亚型。

Objective Radio-frequency ablation of common atrioventricular accessory pathways may result in slow accessory pathways, and subsequently occurrence of permanent junctional reciprocating tachycardia(PJRT).The purpose of the study was to analyze this phenomenon. Method Six cases of tachycardia with above phenomenon were analyzed by the following features: characteristics of tachycaridia, target graph, decrement conduction and distribution of slow accessory pathways.Result All 6 slow accessory pathways resulted from non-thorough radio-frequency ablation and had the features of decrement conduction, VA non-fusion in thetarget graph [retro-conductive time was 60-160 (104.8±38.3)ms and A wave appeared 9-20 (15.3±4.9)ms earlier than the earliest control point].Conclusions Except congenital origin, slow accessory pathways can be resulted from non-thorough radio-frequency ablation.Therefore, slow accessory pathways can be classified into two subtypes: congenital and acquired according to the origin.