显性房室旁道射频消融术后T波改变的临床意义

通过对房室旁道 (简称旁道 )消融术后T波改变的动态观察 ,探讨其临床意义。 12 4例消融成功的单旁道患者分为隐匿性旁道组 (n =5 6 )、轻度预激组 (n =2 4)和明显预激组 (n =44 )。记录消融术前、术后即刻、术后 1h、术后 1天及随访 1～ 3个月期间 12导联心电图 ,比较评价消融术前后T波改变。消融术后超声心动图检查及测定心肌酶。结果 :术后 2 4h明显预激组 2 7例 (6 1% )T波明显改变 ,轻度预激组 4例 (17% )T波明显改变 (P <0 .0 1)。隐匿性旁道组无 1例T波改变。室间隔 (87% )及左侧旁道 (77% )消融术后T波改变多于右侧旁道 (36 % )。T波改变与消融能量及心肌酶升高程度无关 ,与术前预激程度及旁道部位有关。术后 1～ 3个月T波改变者均完全恢复正常。结论 :提示显性旁道射频消融术后T波改变为电张调整性T波改变 ,非心肌损伤所致。

Clinical Significance of T-wave Changes After Radiofrequency Catheter Ablation of Overt Accessory Pathways

The purpose of this study was to characterize the incidence of T wave abonormalities after ablation of overt accessory pathways(AP) and the time course of their development,and to identify the clinical significance of T wave changes.One hundred twenty four patients undergoing successful catheter ablation of an AP were divided into three groups:concealed AP group( n=56 ),mild AP group( n=24 ) and marked AP group( n=44 ).A 12 lead electrocardiogram(ECG) was recorded at the beginning of the ablation procedure as well as immediately and 60 minutes and 1 day after ablation and 1 and 3 months of follow up.The postablation ECG were compared with the preablation ECG to evaluate changes of T wave after ablation.An echocardiographic evalution and serial creatinine kinases(CK MB) determinations were performed after ablation.Results:Immediately after loss of preexcitation,27 patients(61%) with a marked AP group and 4(17%) patients with mild AP group showed T wave marked changes( P<0.01 ).None of the patients with concealed AP had T wave changes after ablation.T wave changes were more frequent after septal AP and left AP ablation(87%,77% vs 36% in right AP).T wave changes:(1)did not correlate with the number of energy applications or with markers of tissue injury;(2)correlated with the degree of preexcitation and the location of the AP,respectively;and (3)completely resolved over a period of three months.Conclusion:T wave changes after ablation are most likely caused by electrotonic modulation,and are not a sign of myocardial injury.