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。     

食管心房调搏在室上速诊断中价值新探讨

目的：评价食管心房调搏对室上性心动过速诊断的准确性。方法：将111例室上速患者心内和食管电生理检查结果进行比较。结果：111例室上性心动过速患者中，经食管心房调搏检查，诊断为房室结内折返性心动过速（AVNRT）41例，准确率91％；诊断为房室折返性心动过速（AVRT）53例，准确率92％；诊断为房性心动过速（AT包括房内折返陛心动过速和房性自律性心动过速）6例，准确率100％；诊断为窦房结折返性心动过速（SART）1例，准确率100％。根据PE-PV1时距判定房速激动起源点以及左右房室旁道位置与心内电生理检查结果基本一致。结论：食管心房调搏在室上速诊断中具有很高的价值。     

经食管心脏电生理检查误诊房室折返性心动过速的不典型房室结折返性心动过速的特点及分析

目的探讨食管电生理检查中被误诊为房室折返性心动过速的不典型的慢快型房室结折返性心动过速的特点。方法回顾性分析5例误诊为房室折返性心动过速患者的食管电生理及心内电生理资料。结果 5例患者在食管电生理检查S1S2程控期前刺激中,均未观察到S2-R间期有跳跃性延长,心动过速的R-P-EB间期70ms;逆行P-波在V1导联直立,下壁导联倒置;食管电生理诊断为左后间隔隐匿性旁道参与的房室折返性心动过速。心内电生理诊断为慢快型房室结折返性心动过速,并成功消融慢径路。结论部分R-P-EB间期70ms的不典型慢快型房室结折返性心动过速食管电生理特点与后间隔隐匿性旁道参与的房室折返性心动过速类似,必要时需心内电生理检查加以明确。     

经食管心房调搏诱发及终止预激综合征房室折返性心动过速的研究

目的探讨经食管心房调搏诱发和终止预激综合征阵发性房室折返性心动过速的价值.方法对30例预激综合征患者行食管心房调搏程控刺激.结果经食管心房调搏对房室折返性心动过速的诱发率,典型预激综合征A型与B型差异无显著意义(P＞0.05),典型预激综合征与詹姆斯型预激综合征差异则有非常显著意义(P＜0.05).心房刺激诱发顺向型房室折返性心动过速的关键因素是旁道有效不应期大于房室交接区有效不应期.结论典型预激综合征的类型对诱发房室折返性心动过速无明显影响;诱发的关键因素是旁道有效不应期大于房室交接区有效不应期;猝发法是终止发作的最有效方法之一,转复成功率接近100%.     

食管心房调搏对顺向型房室折返性心动过速旁道定位的作用

食管心房调搏安全、简便、可靠，对快速心律失常的诊断、鉴别诊断与定位有着重要的临床价值。本文通过对食道调搏时被诊断为顺向型房室折返性心动过速(OAVRT)的58例患者，进行旁道定位与心内电生理检查结果的对比，评价食管心房调搏对OAVRT旁道定位的作用。     

经食管心房调搏对不同类型房室结折返性心动过速的诊断价值

目的:探讨经食管心房调搏对不同类型房室结折返性心动过速诊断的准确性。方法:收集近5个月经心内电生理检查（标准诊断）确诊为房室结折返性心动过速（AVNRT）196例，与其食管调搏的诊断进行比较。结果:两种电生理检查诊断慢-快型AVNRT符合率100%，但食管电生理检查对快-慢型AVNRT及慢-慢型AVNRT与起源于心房下部靠间隔的房速不易鉴别。结论:经食管心脏电生理检查对慢-快型AVNRT具确诊价值。对快-慢型或慢-慢型AVNRT容易误诊为房速。     

显性预激综合征与房室折返性心动过速100例分析

分析１００例显性预激综合征食管心房调搏的资料，结果表明：①诱发顺向型房室折返性心动过速（Ｏ－ＡＶＲＴ）４９例，左侧旁道（ＡＰ）较右侧ＡＰ发生率高；逆向型房室折返性心动过速（Ａ－ＡＶＲＴ）３例，均见于右侧ＡＰ。前向与逆向的单次折返１３例。房室折返性心律失常总计６５例，占６５％。②Ｏ－ＡＶＲＴ的形成应具备旁道前传的有效不应期（ＡＰＡ－ＥＲＰ）＞房室结有效不应期（ＡＶＮ－ＥＲＰ）＞左房有效不应期（ＬＡ－ＥＲＰ）。Ａ－ＡＶＲＴ的形成，应具备ＡＶＮ－ＥＲＰ＞ＡＰＡ－ＥＲＰ＞ＬＡ－ＥＲＰ。③房室折返性心动过速的诱发以Ｓ_１Ｓ_２及分级递增法为最佳。     

食管心房调搏指标诊断室上性心动过速价值的评定

以射频消融结果为依据，评定Ｓ２Ｒ跃增值和ＲＰＥ时距对４８例慢－快型房室结折返性心动过速和１４１例顺向型房室折返性心动过速患者的诊断及鉴别诊断价值，并讨论两类心动过速食管调搏的定量差别标准。     

房室结／隐匿性旁道折返性心动过速食管调搏诊断指标的评价

为提高食管调搏对折返性心动过速的诊断准确率,对30例房室结折返性心动过速和35例隐匿性旁道折返性心动过速作食管调搏(该65例诊断结果与射频消蚀诊断一致率为98.5%).结果显示:电刺激重复诱发和终止以及心动过速时R-P/P-R<1诊断两型的必备指标;室上速第1个P-R间期<240ms、房室结双径路、R-P间期<70ms或>95ms、P_(v_1)-P_E时距≥25ms、P与QRS重叠、QRS后逆行P等是鉴别两型的综合指标.认为食管调搏多指标综合分析对诊断两型折返性心动过速及指导治疗有重要意义.     

房室结双径路与房室旁道并存的室上性心动过速电生理特性及临床意义

经食管心房调搏诊断房室结双径路 (DAVNP)与房室旁道(AP)并存的室上性心动过速 (SVT) 2 5例 ,其中 1例为Kent束“旁观”的房室结折返性心动过速 (AVNRT) ,2 4例均在S2 R跳跃值≥ 60ms诱发SVT ,RPESO3 63 .60± 2 0 .80ms(>70ms)。其常规ECG逆行P波及ST T改变均有别于AVNRT ,慢径前传型AVRT。正确诊断有助于射频消融靶点的选择     

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     

阵发性室上性心动过速时ST－T改变的临床意义

回顾性分析经射频消融治疗的４１８例阵发性室上性心动过速（ＰＳＶＴ）发作时的体表１２导联心电图，以了解ＳＴ－Ｔ改变的临床意义。结果表明３０５例房室折返性心动过速（ＡＶＲＴ）中，ＳＴ段下移≥２ｍｍ且持续≥８０ｍｓ和（或）Ｔ波倒置者有１８１例（５９．３４％），明显高于房室结折返性心动过速（ＡＶＮＲＴ）患者（２８／１１３，２４．７８％）Ｐ＜０．００５。并且此差异不能被心率所矫正。此外左游离壁旁道患者ＳＴ段压低多分布在Ｖ３～Ｖ６导联，而右后和左后隔旁道患者倒置的Ｔ波和（或）ＳＴ段压低多发生于Ｉ、ＩＩ、ａＶＦ导联。提示ＰＳＶＴ时心电图上ＳＴ－Ｔ改变可作为区分ＡＶＲＴ和ＡＶＮＲＴ的一个有用指标，并且可能还有粗略的旁道定位价值     

房室折返和房室结折返性心动过速患者的个性分析

目的探讨房室折返性心动过速(AVRT)和房室结折返性心动过速(AVNRT)患者的个性特征。方法采用龚耀先修订的艾森克个性问卷量表,对83例AVRT、105例AVNRT患者射频消融前后和50例对照组正常人的精神质(P)、内外向(E)、情绪稳定性(N)和掩饰倾向(L)值进行测量。结果射频消融前后,各组之间的P、E、N和L值相比较差异无显著性(P>0.05);射频消融前后AVNRT组内女性患者的N分值较男性高(分别为12.93±2.83vs9.88±2.61;12.84±2.87vs9.87±2.64;P均<0.05)。结论AVNRT女性患者具有神经质倾向,这可能是在AVNRT中女性占多数的原因之一。     

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一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例慢一快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与慢一快型房室结折返性心动过速，敏感性75％，特异性可达1009／6。结论：希氏束旁刺激法对鉴别诊断AVRT与AVNRT有较高的特异性。     

Catheter ablation of anteroseptal accessory pathway in the non-coronary aortic sinus.

We report a patient with atrioventricular reentrant tachycardia (AVRT) with bidirectional conduction over an anteroseptal accessory pathway (AP) who underwent successful ablation in the non-coronary aortic sinus (AS). In three previous attempts, the intracardiac recordings showed an anteroseptal AP with antegrade and retrograde conduction that failed to be ablated in spite of radiofrequency (RF) applications from the right and left anteroseptal regions. During the study, the earliest atrial activation during tachycardia was recorded in the non-coronary AS preceding the atrial activation at the His bundle (HB) region by 24 ms, and the anteroseptal AP was successfully blocked by one single ablation in the non-coronary AS. These data strongly suggest that careful mapping of an anteroseptal AP in the non-coronary AS may provide an alternative ablation approach in patients with previously failed ablation.     

食管电生理诊断阵发性室上性心动过速

目的探讨食管电生理诊断阵发性室上性心动过速(paroxysmal supraventricular tachycardia,PSVT)及分型的准确性。方法收集经食管电生理和心内电生理检查并行射频消融治疗的PSVT42例,将两种电生理对PSVT的诊断及分型进行比较,用X2检验,以P<0.05为差异有统计学意义。结果两种电生理检查诊断房室结双径路、慢快型房室结折返性心动过速、常见的顺向型房室折返性心动过速差异无显著性,食管电生理对房室旁路的粗略定位准确性较高,但对快慢型房室结折返性心动过速、慢房室旁路参予的房室折返性心动过速与房性心动过速不易辨别。结论食管电生理诊断常见类型的PSVT与心内电生理有相似的价值,且具有无创、简便、费用低等优点;但对不常见或复杂的PSVT不易辨别。     

Clinical and electrophysiological characteristics in patients with atrioventricular reentrant and atrioventricular nodal reentrant tachycardia.

AIM: To compare clinical, electrophysiological characteristics and transcatheter ablation results between two groups of patients, one with atrioventricular reentrant tachycardia (AVRT) and the other with atrioventricular nodal reentrant tachycardia (AVNRT). METHODS: The study population consisted of 94 consecutive patients who underwent endocavitary electrophysiological study and radiofrequency (RF) ablation: 46 patients had AVRT due to an accessory pathway with only retrograde conduction while 48 patients had AVNRT. RESULTS: In relation to general and clinical characteristics, differences between the two groups emerged regarding the age of symptom onset (25+/-16 vs 37+/-17 years, p=0.001), the prevalence of heart disease (8 vs 31%, p=0.001) and the correct diagnosis on surface ECG (50 vs 79%, p=0.001). Clinical presentation was quite similar apart from a higher prevalence of fatigue and sweating in the AVNRT group. Transcatheter RF ablation therapy results were similar. CONCLUSIONS: Patients with AVRT have a lower mean age at arrhythmia symptom onset compared with those with AVNRT and have fewer associated cardiac abnormalities. Clinical presentation is quite similar as well as their outcome after ablation. A correct diagnosis by standard ECG is more frequent in AVNRT.     

房室结折返性心动过速的可能折返机制和分型及其在指导慢径消融中的意义

目的根据房室结存在快径、右侧后延伸（经典慢径）和左侧后延伸（另一条慢径）和折返环路,对房室结折返性心动过速（AVNRT）进行分型,并根据电生理检查和射频消融的结果验证以上分型,同时分析此分型在指导房室结慢径消融中的意义.方法 812例入院进行射频消融AVNRT患者,常规行程序心房和心室电刺激和心内标测.根据AVNRT的类型分别采用消融房室结前传慢径和/或逆传慢径的方法治疗AVNRT.结果采用目前常用的AVNRT的分型方法,812例AVNRT患者中,慢快型659例（81%）、慢慢型81例（10%）、快慢型72例（9%）.所有812例AVNRT患者均消融或改良房室结慢径成功.按AVNRT可能的6种折返环路分型,慢快型649例（80%）、左侧变异慢快型10例（1%）、快慢型和变异快慢型57例（7%）、左侧变异快慢型15例（2%）、慢慢型81例（10%）.结论按房室结快径、右侧后延伸和左侧后延伸可能形成的6条折返环路,对AVNRT进行分型,符合电生理检查和射频消融的结果.此分型对理解AVNRT的折返机制和指导房室结慢径消融治疗AVNRT有较大的意义.     

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.     

从慢慢型和慢快型房室结折返性心动过速电生理特性的差异分析折返环的不同

目的从慢慢型房室结折返性心动过速（AVNRT）和慢快型AVNRT的电生理特性的差异分析两型AVNRT间折返环的不同.方法在500例AVNRT患者中的59例慢慢型和60例慢快型之间,比较部分电生理特性的异同;同时在部分慢慢型和慢快型患者中应用2种方法（1）比较起搏时和心动过速时的HA间期的长度;（2）比较心动过速时心室刺激重整心动过速的不同.比较下传共径（LCP）的异同.结果慢慢型的前传慢径和逆传慢径有明显不同的传导时间;慢慢型的逆传慢径与慢快型的逆传快径有明显不同的传导时间和递减特性;和慢快型相比,2种方法均显示慢慢型有较长的LCP.结论 （1）慢慢型AVNRT中前传慢径和逆传慢径的传导时间明显不同;慢慢型较慢快型有较长的下传共径;（2）研究结果支持慢慢型AVNRT可能应用房室结的右侧后延伸和左侧后延伸分别形成心动过速的前传和逆传支而形成折返.