房室结折返性心动过速慢径路改良治疗 (附86例临床分析)

Slow pathway modification therapy for atrioventricular node re-entrant tachycardia

目的:检测房室结折返性心动过速(ANRT)慢径路消融期间常见的结性心动过速的周长(CLJT),以探讨手术期问发生的CLJT与发生房室传导阻滞(AVB)的关系。方法:回顾性分析86例经慢径路改良治疗的ANRT患者的资料。结果:在射频消融期间,86例术中有83例出现了结性心动过速。其中8例出现了AVB(Ⅰ度6例,Ⅲ度2例),另有12例出现了逆行性结一房传导阻滞。在这20例传导阻滞患者中,结性心动过速属于快速性的,其最小周长为301±51 ms;其它63例其最小周长显著延长(529±118 ms,P<0.0001)。结论:慢径路改良治疗期间所见的周长在350 ms以下的快速结性心动过速预示传导阻滞,为了防止AVB的发生应立即终止射频消融。

Objective: To investigate the relations between the cycle length of the junctional tachycardia and atrioventricular block during operation. Methods: Retrospectively analysis the date of patients with atrioventricular node re-entrant tachycardia undergoing slow pathway modification. Results: During radiofrequency ablation, junctional tachycardia developed in 83 of 86 procedures. Eight patients had evidence of AV block (first degree in six patients and third degree in two), and 12 others had retrograde junctional-atrial (J-A) block. In these 20 patients, the junctional tachycardia was rapid, with a minimum cycle length 301±51 ms. There was a longer minimum cycle length (529±118 ms) in other 63 patients (P<0. 0001). Conclusion: Fast junctional tachycardia with cycle lengths <350 ms during slow pathway modification predicted the occurrence of conduction block. Radiofrequency ablation should be ended immediately to prevent development of AV block.