马汉姆纤维的自律性以及对有效消融的反应

Automaticity of Mahaim fiber and it's response to effective ablation

目的报道马汉姆纤维的自律性以及对有效消融的反应。方法对 13例马汉姆纤维患者 (心房 心室型 10例 ,心房 分支型 3例 ) ,进行心内电生理检查和射频导管消融治疗。观察术中窦性心律和消融放电时 ,马汉姆纤维自主心律的发生和特点。结果 2例患者在窦性心律时出现反复短阵马汉姆纤维自主心律 ,频率 6 5～ 72次 /min ,QRS波形态相同于逆向型房室折返性心动过速。成功消融阻断 13例患者的马汉姆纤维 ,18次有效消融中 14次 (敏感性 78% )出现不规则的加速性马汉姆纤维自主心律 ,持续 1.2～ 14s ;5 4次无效消融均无马汉姆纤维的自主心律 (特异性 10 0 % )。结论马汉姆纤维具有自律性 ,消融放电中出现的加速性马汉姆纤维自主心律可以作为判定有效消融的预测指标。

Objective This study is to elucidate the automaticity of Mahaim fiber and its response to effective ablation.Methods Thirteen patients with Mahaim fiber (including ten atrioventricular and three atrio-fascicular accessory pathways)had been performed electrophysiological study and radiofrequency catheter ablation. The incidence and characteristics of an automatic rhythm originating from Mahaim fiber during the whole procedure (especially during radiofrequency current delivery) were observed.Results Repetitive and short-run automatic rhythm (rate: 65～72bpm) with a QRS morphology similar to that of clinical preexcited atrioventricular reentrant tachycardia occurred in two patients during sinus rhythm. Conduction of Mahaim fiber was successfully eliminated by radiofrequency energy in all thirteen patients. Among the eighteen effective applications of radiofrequency current, fourteen were associated with irregularly accelerated automatic tachycardia of Mahaim fiber (with a sensitivity of 78%), lasting for 1.2～14 seconds. However, such automatic tachycardia of Mahaim fiber did not occured during fifty-four failed applications of radiofrequency current. Conclusion The Mahaim fiber has the function of automaticity. The accelerated automatic tachycardia of Mahaim fiber occurred during radiofrequency catheter ablation can be used as a predictor for successful procedure.