Combination therapy with aprindine and verapamil for paroxysmal supraventricular tachycardia as assessed by transesophageal atrial pacing

To assess the efficacy of combination therapy of aprindine (40 mg/day) and verapamil (160 mg/day), transesophageal programmed atrial stimulation was performed on 21 patients with paroxysmal supraventricular tachycardia (including 12 patients with atrioventricular nodal reentrant tachycardia and nine patients with atrioventricular reentrant tachycardia) under four conditions: a) control, b) aprindine alone, c) verapamil alone, and d) aprindine + verapamil. Results: a) Aprindine, verapamil, and aprindine + verapamil prevented paroxysmal supraventricular tachycardia induction in 2/21, 3/21, and 9/21 patients, respectively;b) aprindine + verapamil prolonged the cycle length of paroxysmal supraventricular tachycardia more than aprindine or verapamil alone; c) aprindine, verapamil, and aprindine + verapamil decreased the AV blocking rate by 15, 23, and 35 beats/min, respectively, in comparison with the control state; d) aprindine, verapamil, and aprindine + verapamil prolonged the effective refractory period of atrioventricular conduction system by 20, 34, and 76 msec, respectively, compared with the control state. In conclusion, aprindine + verapamil appear to be more effective than aprindine or verapamil alone in preventing paroxysmal supraventricular tachycardia with nodal reentry, but there was less benefit in those without nodal reentry (Wolff-Parkinson-White group).     

经食管心房调搏对阵发性室上速诱发与终止的临床价值

目的：研究经食管心房调搏对阵发性室上性心动过速（PSVT）诱发与终止的价值。方法：选择237例有心动过速发作史的患者进行食管心房调搏检查,如果诱发出阵发性室上速,进行12导联心电图记录后,予以短阵快速刺激或程序期前刺激终止之。另外对54例急诊PSVT患者直接予以短阵快速刺激或程序期前刺激终止之。结果：在被检的237例患者中诱发出PSVT148例,占62．4％（其中房室结双径87例,房室折返为61例）。对其202例PSVT患者均采用短阵快速刺激或程序期前刺激。PSVT即刻终止的有196例,转复成功率97％。结论：经食管心房调搏可作为PSVT筛选检查及终止的首选方法。     

经食道心房调搏诊断阵发性室上性心动过速的临床价值

目的探讨经食管心房调搏（TEAP）检查诊断阵发性室上性心动过速（PSVT）的临床价值。方法纳入临床诊断为PSVT患者74例,通过TEAP检查予以诱发以及终止PSVT,记录并分析PSVT心电图参数,包括诱发窗口、诱发频率、房室结不应期等,并与心腔内电生理（IEPS）检查结果进行比较。结果 TEAP检查的诱发窗口、诱发频率、房室结不应期与IEPS检查结果相关性良好（P＜0.05）, TEAP检查诊断PSVT的符合率达83.8%（62/74）,诱发的PSVT均能通过TEAP予以终止。结论 TEAP检查可有效评估PSVT的电生理特性,准确率高,值得临床广泛应用。     

射频消融术前行经食管心房调搏检查的临床意义

选取初步诊断为阵发性室上性心动过速（PSVT）欲行射频消融（RFCA）的患者328例，在做RFCA之前均先行经食管心房调搏（TEAP）检查。在检查过程中，每例患者均诱发出心动过速，在心动过速时应用多导心电图（ECG）同时记录，并通过TEAP时多导ECG标测资料与心内电生理资料进行对比观察，找出TEAP检查对PSVT的诊断规律并对其进行评价。结果本组328例初诊为PSVT患者在行TEAP检查之后均做了心内电生理检查并且射频消融均获成功；其中316例TEAP诊断与心内电生理及射频消融结果符合，TEAP与心内电生理符合率为96．4％。TEAP 12例不符合诊断病例，其诊断错误主人由于P波记录不表、RP标测不准确及不能做心室起搏观察室房逆行传导等局限性造成。认为在PSVT射频消融手术之前行TEAP电生理检查，可初步了解PSVT性质、分类，明确诊断，简化射频消融操作手续，缩短手术时间，减少患者痛苦，降低放射线照射的损害等优点，值得临床推广应用。     

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     

Comparative study of transesophageal atrial pacing and intracardiac electrophysiology in patients with supraventricular tachycardia

The diagnostic value of transesophageal atrial pacing in supraventricular tachycardia (SVT) has been discussed according to the comparison of the results of intracardiac and transesophageal electrophysiological study. Some quantitative criteria for the differential diagnosis of atrioventricular node reentrant tachycardia (RT-AVN) and atrioventricular reciprocating tachycardia (RT-AP) has been proposed. We found that RT-AVN and RT-AP could be separated by noninvasive transesophageal atrial pacing. We also suggested that induced SVT would be RT-AVN if (1) SR conductive curve was not continuous and SR jump greater than 70 ms, (2) AV interval less than 60 ms, and it would be RT-AP if (1) SR curve was continuous and there was no SR jump phenomenon, (2) VA interval greater than 100 ms. Thus, transesophageal atrial pacing was very helpful in distinguishing the mechanisms of SVT and could provide a simple clinical cardiac electrophysiological procedure in diagnosing SVTs.     

异丙肾上腺素在食道心房调搏术诱发阵发性室上性心动过速中的应用

目的:对比观察食道心房调搏术中基础刺激与基础刺激加异丙肾上腺素诱发室上性心动过速的诱发率。方法:302例临床拟诊阵发性室上性心动过速的患者被随机分成两组:基础刺激组(A组)151例,基础刺激加用异丙肾上腺素组(B组)151例,然后进行食道心房调搏检查。结果:B组的诱发成功率明显高于A组的(72.8%:41.1%,P0.01)。同时B组患者中,房室结双径路的诱发成功率明显大于房室旁道(76.8%:57.5%,P0.05)。结论:异丙肾上腺素能显著提高食道心房调搏术中阵发性室上性心动过速的诱发率,值得临床推广应用。     

食管心房调搏超速抑制终止室上性心动过速52例报告

室上性心动过速是最常见的心律失常之一 ,有时相当顽固难以控制 ,严重影响患者生活与工作 ,甚至造成血流动力学障碍而危及生命 ,抗心律失常药物有时很难奏效。我院应用食管心房调搏超速抑制治疗室上性心动过速 5 2例 ,现将结果报道如下。1　资料和方法1 1　病例选择　 2 0 0 0 - 0 3～ 2 0 0 2 - 10因阵发性室上性心动过速在我院就诊治疗的 5 2例患者 ,其中男性 3 3例 ,女性19例 ,年龄 14～ 65岁 ,平均 3 8岁。所有患者既往均有室上性心动过速发作病史 ,病史最短者 3个月 ,最长者 3 7年。其中预激综合征患者 2 8例 ,房室结双径路患者 2 1例 …     

食管心房调搏对阵发性室上性心动过速发病机制研究

使用无创伤性食管心房调搏（TEAP）心电生理检查法，对58例原因不明的阵发性室上性心动过速（PSVT）在非发作期进行程控或非程控心脏刺激，旨在探讨PSVT的发病机制，电生理特征以及TEAP对其临床研究的价值。结果：诱发示PSVT的共47例（折返机制），占81．0％，不能诱发11例（非折返机制），占19．0％。说明折返机制系PSVT的主要发病机制。又根据程控刺激中所表现的不同心电生理特征，47例折返性PSVT又可分为不同机制的折返。其中房室结内折返性23例，房室折返性17例，心房内或窦房折返性7例，说明前两种折返系折返性PSVT的主要折返机制，与国内外报道相似。     

Effect of verapamil in infants with paroxysmal supraventricular tachycardia.

Twenty-nine consecutive spontaneous attacks of paroxysmal supraventricular tachycardia (PSVT) in 14 infants (mean age 4.4 months) were treated with verapamil. No infant had associated heart disease. Verapamil 1-2 mg i.v was administered over 30 seconds. The dosage varied according to the weight of the infant. Within 60 seconds sinus rhythm was obtained in 28 instances (96.5%). No significant complications were observed. The high effectiveness, rapid action and lack of undesirable side effects observed in this series suggest that verapamil is the drug of choice in the treatment of PSVT in infants without underlying heart disease.     

经食管心房起搏终止室性心动过速22例临床分析

经食管心房起搏常用于室上性心动过速（室上速）的诊断和治疗，而用于终止室性心动过速（室速）则报道较少。从理论上讲，如室上性冲动能夺获心室或采用超速起搏抑制均有可能打断折返环进而终止室速。虽终止室速的成功率远不及室上速，但若成功则病人免受直流电击之苦，且该方法简便、易行。为此，本期特刊出马红梅等撰写的文章，较为详尽地介绍了采用该法的适应证、具体方法及其效果，以期引起关注，共同探讨。[编者按]     

射频消融治疗快速心律失常300例回顾分析

目的 总结射频消融术（ＲＦＣＡ）治疗快速心律失常经验和教训,以利提高疗效。方法 回顾分析我院自１９９３年４月～１９９９年８月共治疗３００例ＲＦＣＡ。快速心律失常类别包括：房室结折返性心动过速（ＡＶＮＲＴ）７８例;房室折返性心动过速（ＡＶＲＴ）２０１例;特发性室性心动过速（ＩＶＴ）１３例;阵发性心房扑动（ＡＦ）７例;快心室率（≥１００次/分）心房颤动房室结改良１例。均先行心内电生理检查,寻找最佳靶点进行消融。结果 消融总成功率为９７．３％,总复发率为３．４％,并发症发生率１．７％,无死亡病例。结论 射频消融已成为快速心律失常简捷有效的治疗方法,但有目的地预测和降低并发症,识别和正确处理特殊病例,是提高成功率的关键。     

室上速并发心房颤动的电生理研究

目的探讨室上速并发心房颤动(房颤)的电生理特性及其发生机制。方法对38例室上速患者,根据有无房颤史分为两组,即房颤组18例,无房颤组20例。分别测量两组室上速周长、心房内压、心房各部位有效不应期、心房不应期离散度、心房最大不应期与室上速周长的比值,所有对象均行射频消融术治疗室上速,并行为期半年的随访,观察两组病人房颤的发生情况。结果房颤组与无房颤组的室上速周长分别为（326±9）ms,（331±11）ms,P>0.05。在窦性心律与室上速发作时,房颤组的心房不应期离散度均较无房颤组增加,房颤组的心房最大不应期与室上速周长的比值比无房颤组明显增加（P<0.05）。房颤组的心房最大不应期比无房颤组增加（P<0.05）,但却发生在心房的不同部位。结论(1)室上速合并房颤与室上速周长无明显关系。(2)心房不应期离散度是室上速合并房颤发生和维持的一个重要机制。(3)心房最大不应期与室上速周长的比值可能是室上速诱发房颤的另一个机制。     

Treatment of atrial flutter and rapid atrial tachycardia with transesophageal atrial pacing

Eight patients with atrial flutter (AF) and rapid atrial tachycardia (AT) (5 common AF, 1 uncommon AF and 2 AT) were treated with transesophageal atrial pacing (TEAP). In 5 patients no antiarrhythmic agent was used during this study, and in 3 patients procainamide was administrated intravenously. Conversion to sinus rhythm was successfully achieved in 7 patients (5 common AF and 2 AT). Two patients were converted to sinus rhythm immediately after pacing, and transient atrial fibrillation was induced before conversion to sinus rhythm in 5 patients. TEAP failed to terminate the arrhythmia in 1 patient with uncommon AF. Administration of procainamide reduced the atrial rate in 2 common AF and 1 AT, which were successfully converted to sinus rhythm by TEAP, but induced a rapid ventricular response in 2 patients, one of whom also developed hypotension before conversion. No significant complication due to TEAP was observed in this study. In conclusion, TEAP is a noninvasive method with fewer complications and has nearly the same high efficacy for converting AF and rapid AT to sinus rhythm as DC cardioversion or transvenous atrial pacing.     

舌下含服维拉帕米治疗阵发性室上性心动过速临床研究

目的 探讨舌下含服维拉帕米对阵发性室上性心动过速(PSVT)的治疗作用.方法 经心电图检查确诊的42例PSVT患者随机分成二组,舌下含服维拉帕米组22例(A组)和静脉注射维拉帕米组20例(B组).分别于用药前、PSVT终止后记录血压、心率、起效时间(用药后心率下降达20次/分以上时为起效时间)和PSVT终止时间,并记录症状改善情况.结果A组:起效时间(7.05±1.79)分钟,PSVT终止时间(11.14±8.82)分钟,成功率90.90%;B组:起效时间(7.27±3.13)分钟,PSVT终止时间(9.15±6.81)分钟,成功率95.00%.二组比较疗效差异无显著性(P>0.05).结论 该方法简单起效快,疗效好,无明显副作用,具有推广应用价值.     

Comparison of verapamil and practolol in paroxysmal supraventricular tachycardia.

40 patients with paroxysmal supraventricular tachycardia were allocated to two different treatment groups according to their year of birth. Those patients born on odd years were given 5 mg of practolol intravenously, those born on even years receiving 5 mg of verapamil, and if the tachycardia continued, the same injection was repeated after 5 minutes. If practolol treatment failed, the patient was given 5 mg of verapamil half an hour later, and vice versa. Verapamil restored sinus rhythm in 19 patients out of 20. Practolol proved effective in 8 out of 20. In patients who were switched over to the other treatment verapamil was effective in 9 out of 11 and practolol in 1 patient. Side effects were few. Marked hypotension occurred in 2 patients, in 1 patient after 5 mg of verapamil, and after 5 mg of practolol in the other. It is concluded that verapamil is a very effective agent in the treatment of paroxysmal supraventricular tachycardia. Selection of patients is emphasized to increase the safety of its use.