希氏束旁起搏鉴别间隔部隐匿性AVRT与AVNRT的临床价值

目的探讨希氏束旁起搏鉴别间隔部隐匿性房室旁道与慢-快型房室结折返性心动过速(AVNRT)的临床价值. 方法采用希氏束逆传不应期心室早搏刺激法将61例患者分别诊断为37例慢-快AVNRT和24例间隔部房室折返性心动过速(AVRT);再对61例患者采用希氏束旁起搏方法进一步检测. 结果采用希氏束旁起搏法检测37例AVNRT患者中有6例未检测成功,其余31例均为逆传房室结图形;24例AVRT患者中4例未检测成功,15例呈逆传旁道/旁道图形,5例呈非逆传旁道/旁道图形.如以逆传旁道/旁道图形为标准,鉴别间隔快旁路引起的AVRT与慢-快型房室结折返性心动过速,敏感性75%,特异性可达100%.结论希氏束旁刺激法对鉴别诊断AVRT与AVNRT有较高的特异性.     

希氏束旁起搏鉴别间隔部隐匿性房室快旁道的临床价值

目的:探讨希氏束旁起搏鉴别间隔部隐匿性房室快旁道的临床价值。方法:采用希氏束逆传不应期心室期前收缩刺激法,将142例患者诊断为慢-快型房室结折返性心动过速(AVNRT)74例和间隔部隐匿性房室折返性心动过速(AVRT)68例。对142例患者采用希氏束旁起搏方法进一步检测。结果:希氏束旁刺激法检测结果显示,74例AVNRT患者中8例未检测成功,其余66例均为逆传房室结图形;68例AVRT患者中6例未检测成功,其余62例患者中48例均呈逆传旁道/旁道图形,14例呈非逆传旁道/旁道图形。如果以逆传旁道/旁道图形为标准鉴别间隔部快旁道引起的AVRT与慢-快型AVNRT,敏感性为77%,特异性为100%。结论:希氏束旁刺激法对间隔部隐匿性房室快旁道的鉴别诊断有很高的特异性。     

右中间隔心底部和心尖部刺激鉴别间隔部隐匿性房室旁道的作用

目的评价右中间隔心底部和心尖部刺激对间隔隐匿性房室折返性心动过速(AVRT)的诊断价值。方法通过希氏束逆传不应期行心室早搏刺激法将142例患者分为74例慢-快型房室结折返性心动过速(AVNRT)和68例间隔隐匿性快旁道引起的AVRT患者,成功消融前均常规行腔内电生理检查,并在此基础上加用同频率右中间隔心底部和心尖部刺激:窦性心律时以120次/min的相同频率,分别刺激心尖和心底部,比较各自右心室的V波至逆传心房产生逆传A波的时限(VA)。结果希氏束逆传不应期行心室早搏刺激检测结果:心动过速时,希氏束逆传不应期内心室早搏刺激,74例快-慢型AVNRT患者心房激动不能提前(变化小于10ms),68例AVRT患者心房均被提前激动超过20ms(30～50ms)。同频率心尖部和右中间隔心底部刺激法检测结果:心尖部刺激所测的VA减去自身心底刺激所测的VA差值AVNRT患者为-65～6(-41±17)ms;间隔旁道引起的AVRT患者22～63(34±10)ms,两者间差异有统计学意义(P<0.01)。各例间隔旁道引起的AVRT患者的差值均大于10ms,各例AVNRT患者均小于10ms,两者间无重叠现象出现。5例AVNRT患者和3例间隔旁道引起的AVRT患者检测失败。结论窦性心律时同频率心尖部、右中间隔心底部起搏刺激法鉴别诊断AVRT和AVNRT的敏感性和特异性很高,而且操作简单,便于在临床上推广应用。     

不典型房室结折返性心动过速与房室折返性心动过速的电生理鉴别

房室结折返性心动过速(AVNRT)与房室折返性心动过速(AVRT)的鉴别有时较困难,尤其是不典型AVNRT与间隔旁道参与的AVRT鉴别,不典型AVNRT在心动过速发生时最早心房激动位于后间隔区域,与后间隔旁道引起的AVRT相似。通常检测房室结双径路的电生理方法仅能鉴别63%的不典型AVNRT。该文介绍了两者的主要电生理鉴别方法,包括希氏束旁起搏、在希氏束不应期给予心室期前程序刺激、心室或希氏束旁起搏后间期与心动过速周长之差(PPI-TCL)和刺激信号至心房波减去室房(SA-VA)间期的区别、校正的心室PPI-TCL和VA间期、心动过速时VA分离现象及TCL行心室起搏时的VA间期与心动过速时的VA间期之差等9种方法。     

His束逆传不应期心室早搏刺激鉴别间隔隐匿性旁道与房室结折返性心动过速

探讨His束逆传不应期心室早搏刺激法临床应用时的注意事项。 37例慢 快型房室结折返性心动过速(AVNRT)和 2 0例间隔部隐匿性快旁道引起的房室折返性心动过速 (AVRT)患者 ,成功消融前在常规行腔内电生理检查的同时均行His束逆传不应期心室早搏刺激法。结果 :心动过速时His束逆传不应期内心室早搏刺激 ,37例AVNRT患者心房激动无明显提前 ,2 0例AVRT心房被提前激动超过 2 0 (30～ 5 0 )ms ,其中 9例终止心动过速 ,此方法鉴别AVRT和AVNRT特异度、灵敏度较高。结论 :心动过速时His束逆传不应期行心室早搏刺激法鉴别诊断AVRT和AVNRT操作简单、准确性高。但行此法检查时要求有持续发作的心动过速 ;能够标测出清晰的His束电位 ;心室早搏刺激最好与His束电位同步发放 ;反复多次重复检测以进一步提高诊断的正确性     

阵发性室上性心动过速的分型、诊断和治疗

<正> 一、阵发性室上性心动过速(PSVT) 是指起源于希氏束以上的心动过速,按其发生机制可分为三型。 (一)折返型室上速 (1)房室结折返性心动过速(AVNRT),此型最常见。其由房室结内纵向分离的慢、快通道形成折返径路。常见的为慢通道前传型,而由快通道前传的非典型AVNRT少见。(2)房室反复性心动过速(AVRT)。折返环包括心房、心室、房室结和房室旁道(Kent束)。可分为经房室结前传的顺向型和经旁道前传的逆向型二种,前者占90％。隐匿型预激因其旁道仅有逆向传导能力,窦性心律     

食管心房调搏诊断室上性心动过速及与心内电生理对照研究

目的：探讨食管心房调搏（TEAP）揭示室上性心动过速（PSVT）发生机制的价值和局限性。方法，回顾性分析射频消融成功（RECA）的132例PSVT者的TEAP结果，其中隐匿性单房室旁道以与的顺向型房室折返性过速（AVRT）86例，房室结折返性过速46例。结果：86例房室结折返性过速（AVNRT）中，2例例前间壁旁路引起者TEAP均诊断为AVNRT，余为左右侧其它部位的旁路，诊断正确，46例AVNRT中，1例为慢－慢型，1例为快－慢型，TEAP均诊断为AVRT，余为慢－快型，结论：TEAP目前是鉴别两者的最佳无创性方法，但前间隔旁路引起者易误诊为AVNRT，慢－慢型和快－慢型AVNRT易误诊为AVRT。     

同频率心尖部、心底部右中间隔区刺激鉴别间隔部隐匿性旁路和房室结双径路的作用

在诊断间隔隐匿性房室旁路时，希氏束逆传不应期心室早搏刺激法是目前诊断房室折返性心动过速(AVRT)重要的标准。但行此法检查时要求有持续发作的心动过速、心动过速时的周长保持恒定、心动过速时能够标测出清晰的希氏束电位，因此有时影响了其在临床上的广泛应用。国外学者Martinez—Aiday曾提出窦性心律时分别于心尖部和心底部起搏刺激，测起搏的V波与逆传的心房A波即VA间期的方法，以诊断间隔隐匿性旁路。现就我们采用此方法诊断鉴别的体会汇报如下。     

房室旁道合并房室结双径路形成的窄QRS波群心动过速

阵发性室上性心动过速中最常见的类型为房室旁道参与折返形成的顺向性房室折返性心动过速（AVRT）和房室结双径路折返引起的慢快型房室结折返性心动过速（AVNRT）,两者均为窄QRS波群,心动过速频率又比较接近,有时较难鉴别。尤其隐匿性房室旁道合并存在房室结双径路者,因窦性心律时无心室预激表现,     

房室旁道和房室结双径引起的折返性心动过速初次发病年龄和因素分析

探讨房室旁道 (简称房道 )和房室结双径引起的折返性心动过速的初次发病年龄。 15 5例旁道和房室结双径引起的折返性心动过速中 ,房室折返性心动过速 (AVRT) 10 6例、房室结折返性心动过速 (AVNRT) 4 9例。根据年龄和心动过速病程推算初次发病年龄 ,然后比较AVRT和AVNRT、左和右侧旁道并AVRT、显性和隐匿性旁道并AVRT、男性和女性心动过速患者的初发年龄。结果 :AVRT和AVNRT的初发年龄分别为 2 9.9± 12 .85岁和 32 .33±11.84岁 ,组间比较无显著性差异。左、右侧旁道并AVRT、显性和隐匿性AP并AVRT、男性和女性心动过速患者初发年龄比较差异均无显著性 ,均是 30岁左右。结论 :30岁左右是AVRT和AVNRT初次发病的高发年龄段 ,其他年龄段呈散在发病     

Para-Hisian entrainment: a novel pacing maneuver to differentiate orthodromic atrioventricular reentrant tachycardia from atrioventricular nodal reentrant tachycardia

INTRODUCTION: Para-Hisian pacing during sinus rhythm can help to identify the presence of an accessory pathway (AP). In this maneuver, the retrograde activation time and pattern are compared during capture and loss-of-capture of the His bundle while pacing from a para-Hisian position. However, identification of a retrograde AP does not necessitate that it is operative during the tachycardia of interest; conversely, slowly conducting or "distant" bypass tracts may not be identified. We evaluated the utility of entrainment or resetting of tachycardias from the para-Hisian position to help distinguish atrioventricular nodal reentrant tachycardia (AVNRT) from orthodromic atrioventricular tachycardia (AVRT). METHODS AND RESULTS: Para-Hisian entrainment/resetting was evaluated in 50 patients: 33 with AVNRT and 17 with AVRT. The maneuvers were performed using a standard quadripolar catheter placed at the His position: low output for right ventricular (RV) capture and high output for both RV and His capture. The retrograde atrial activation sequence, SA interval (interval from stimulus to earliest retrograde atrial activation), and "local" VA interval (interval between the ventricular and atrial electrograms at the site of earliest retrograde atrial activation) were compared between His and His/RV capture. The DeltaSA was > 40 ms in patients with AVNRT and was < 40 ms in all but one patient with AVRT. In concert with the DeltaSA interval, the DeltaVA interval was able to fully define the mechanism of the tachycardia in all patients studied. CONCLUSION: Para-Hisian entrainment/resetting can determine the course of retrograde conduction operative during narrow complex tachycardias. It is a useful diagnostic maneuver in differentiating AVNRT and orthodromic AVRT.     

Differentiating atrioventricular nodal reentrant tachycardia from tachycardia via concealed accessory pathway

Studies analyzing the diagnostic value of 12-lead electrocardiographic criteria differentiating slow-fast atrioventricular nodal reentrant tachycardia (AVNRT) from atrioventricular reentrant tachycardia (AVRT) due to concealed accessory pathway have shown inconsistent results. In 97 patients (50 with AVNRT, 47 with AVRT) 12-lead electrocardiograms (ECGs) were recorded during sinus rhythm and tachycardia (QRS <120 ms). The ECGs were blinded for diagnosis and patient and analyzed independently by 2 electrophysiologists. The studied criteria differentiating AVNRT from AVRT included pseudo-r'/S, the presence of a retrograde P wave, RP interval, ST-segment depression >/=2 mm with the number and location of the affected leads, QRS amplitude, and cycle length alternans.     

下位法射频消融慢径路改良房室结治疗室上性心动过速23例

用下位法射频消融慢径路改良房室结治疗房室结折返性心动过速(AVNRT)18例,房室折返性心动过速(AVRT)5例.AVNRT中16例为慢—快型,1例快—慢型,1例慢—快型与快—慢型并存,18例慢径路全部阻断成功.AVRT中1例显性预激,4例隐性预激,有5例慢径路和3例房室旁路消融成功.射频放电时21例出现结性心律.无严重并发症出现.AVNRT病人中随仿1—15个月有1例复发,第二次射频成功.认为下位法射频消融阻断慢径路成功率高,并发症少.     

腺苷终止房室结和房室旁道折返性心动过速的心内电生理评价

探讨腺苷对阵发性室上性心动过速 (PSVT)的终止效果 ,观察PSVT终止后出现的心律失常。 2 5例患者 ,其中房室结折返性心动过速 (AVNRT) 11例、房室折返性心动过速 (AVRT) 14例 ,于心内电生理检查时 ,由前臂静脉注射(简称静注 )腺苷 6～ 12mg ,观察其终止心动过速的疗效和作用部位。结果 :11例AVNRT患者静注腺苷后 ,10例恢复窦性心律 ,其中 9例终止AVNRT于慢径前传 ,1例于快径逆传 ;14例AVRT患者静注腺苷后 ,14例均恢复窦性心律 ,终止AVRT 12例于房室结前传 ,2例于旁道逆传。心动过速终止后最常出现的心律失常是房性早搏和一过性Ⅰ和Ⅱ度房室阻滞 ;此外 ,室性早搏也很常见 ,部分患者可出现短阵室性心动过速 ,1例患者出现预激综合征伴心房颤动。结论 :腺苷终止PSVT有较高的成功率 ,但有潜在的促心律失常作用。     

Differentiating atrioventricular nodal reentrant tachycardia from atrioventricular reentrant tachycardia by DeltaHA values during entrainment from the ventricle

BACKGROUND: Differentiating atrioventricular nodal reentrant tachycardia (AVNRT) from orthodromic atrioventricular reentrant tachycardia (AVRT) can be difficult. The His bundle and atria are activated sequentially over the AV node during entrainment of AVNRT from the ventricle but simultaneously during supraventricular tachycardia (SVT). They are activated in parallel during entrainment of AVRT but sequentially during SVT. OBJECTIVE: The purpose of this study was to test the hypothesis that a DeltaHA (HA((entrainment)) - HA((SVT))) cutoff value of 0 reliably differentiates AVNRT from AVRT. METHODS AND RESULTS: Of 61 patients undergoing electrophysiologic evaluation for paroxysmal SVT, retrograde His-bundle potentials were recorded in 57 (93%) and entrainment performed in 49 (34 AVNRT, 15 AVRT). DeltaHA values during entrainment from the ventricle were significantly longer during AVNRT than AVRT (31 +/- 24 ms vs -38 +/- 31 ms, P <.001). All DeltaHA values were positive (minimum: 3 ms) for AVNRT and negative (maximum: -2 ms) for AVRT. DeltaHA of 0 had sensitivity, specificity. and positive predictive value of 100% for correct diagnosis. CONCLUSION: The DeltaHA criterion during entrainment of tachycardia from the ventricle reliably differentiates AVNRT (positive values) from AVRT (negative values).     

食管心房调搏诊断室上性心动过速的临床研究

为探讨食管心房调搏揭示室上性心动过速发生机制的价值和局限性,回顾性分析成功射频导管消融的１３８例隐匿性单房室旁道参与的顺向型房室折返性心动过速和１００例单一类型房室结折返性心动过速的食管心房调搏结果。结果显示：前１３８例中,３例前间隔旁道引起者食管心房调搏均诊断为房室结折返性心动过速余为左右侧其它部位的旁道,诊断正确。后１００例中,５例为慢－慢型,２例为快－慢型,食管心房调搏均诊断为房室折返性心动     

Suppressive effect of SUN1165 on supraventricular tachycardia

The electrophysiologic properties of SUN1165 and its suppressive effect on supraventricular tachycardia were assessed in 14 patients, nine with atrioventricular reentrant tachycardia (AVRT) and five with atrioventricular nodal reentrant tachycardia (AVNRT). This new agent prolonged the PR interval and QRS duration but did not alter the QT interval or the corrected QT interval. It did not alter the sinus cycle length or sinus node recovery time. The drug prolonged the AH interval, HV interval, and intraatrial conduction time but did not change the effective refractory periods of the right atrium or right ventricle. SUN1165 prevented the induction of tachycardia in six of nine patients with AVRT by a complete retrograde block of the accessory pathway and prevented AVNRT in four of five patients by a complete retrograde block of the fast atrioventricular nodal pathway as well. We conclude that SUN1165 is very effective in preventing AVRT or AVNRT. Larger studies with more patients are warranted.     

U Wave during Supraventricular Tachycardia: Simulation of a Long RP Tachycardia and Hiding the Common Type AVNRT

The main tool for the differentiation of supraventricular tachycardia is the 12‐lead electrocardiogram (ECG). Especially differentiating the atrioventricular nodal reentrant tachycardia (AVNRT) from the atrioventricular reentrant tachycardia (AVRT) due to concealed accessory pathway or from an atrial tachycardia (AT) is very important for catheter setting and ablation approach in an electrophysiological study. In our case we saw the occurrence of a U wave during tachycardia—simulating a pseudo P wave. This mimicked a long RP‐tachycardia, although it was a common type AVNRT.