异丙肾上腺素与阿托品诱发阵发性室上性心动过速的对比观察

目的 对比观察异丙肾上腺素与阿托品试验在经食管心房调搏中诱发室上性心动过速的异同。方法 87例阵发性室上性心动过速病人,54例用异丙肾上腺素(Iso组,2μg/min静脉滴注),33例用阿托品(Atr组,0.04mg/kg静脉注射)后重复经食管心房调搏检查。结果 异丙肾上腺素与阿托品诱发成功率分别为83.3%、66.7%,前者略高于后者,但两者无显著差异(P>0.05);异丙肾上腺素诱发房室结折返性心动过速多于房室折返性心动过速,而阿托品诱发房室折返性心动过速多于房室结折返性心动过速,两者有显著差异(P<0.05)。结论 异丙肾上腺素、阿托品均可取得大致相同的阵发性室上性心动过速的诱发成功率,仅在诱发室上性心动过速的类型上有一定差异。     

异丙肾上腺素判定房室结内折返性心动过速消融终点的临床意义

目的 探讨异丙肾上腺素判定房室结内折返性心动过速消融终点的临床意义。方法 对97例房室结内折返性心动过速患者，消融前后作使用及不使用异丙肾上腺素自身对照进行心内电生理检查。结果 70例(95％可信区间63％—81％)可诱发室上性心动过速，消融后观察30min，心内电生理检查不能诱发。27例(95％可信区间19％—38％)消融前不能诱发室上性心动过速，静脉滴注异丙肾上腺素后再重复心内电生理检查，均能够诱发室上性心动过速；消融后观察30min，均无室上性心动过速。结论 判定常规心内电生理检查不能诱发心动过速的房室结内折返性心动过速患者的消融终点。宜在使用异丙肾上腺素后再重复同样程序的刺激，并以不能诱发为指标。     

异丙肾上腺素逆转莫雷西嗪抑制室上性心动过速电诱发及其临床意义

选择２０例阵发性室上性心动过速（ＳＶＴ）患者进行莫雷西嗪（Ｍｏｒ）、美托洛尔（Ｍｅｔ）和异丙肾上腺素（Ｉｓｏ）的电药理监测。结果表明，Ｍｏｒ对ＳＶＴ电诱发的总抑制率达９０％，Ｉｓｏ对Ｍｏｒ抑制ＳＶＴ电诱发的总逆转率达２２％，Ｉｓｏ对Ｍｏｒ和Ｍｅｔ合用后抑制ＳＶＴ电诱发的逆转作用消失或减弱，提示在交感神经兴奋时，即使服用Ｍｏｒ，部分患者仍会有ＳＶＴ临床复发，加用β－受体阻滞剂可以预防。     

异丙肾上腺素提高食管心房调搏术对阵发性室上性心动过速的检出率

目的:探讨异丙肾上腺素提高食管心房调搏术(TEAP)对阵发性室上性心动过速(PSVT)检出率的作用。方法:在85例怀疑有PSVT发作史患者行常规TEAP(基本刺激),对于未能诱发PSVT者,静脉滴注异丙肾上腺素使心率增快至120次/min,再重复TEAP。结果:常规食管心房调搏术诱发PSVT 29例(34.1%,29/85),未能诱发PSVT的56例加静脉滴注异丙肾上腺素,再重复TEAP,诱发PSVT54例(96.4%,54/56),这检出率显著高于常规TEAP的检出率(96.4%比34.1%,P=0.039)。结论:静脉滴注异丙肾上腺素能大大提高食管心房调搏术对阵发性室上性心动过速的检出率。     

异丙肾上腺素逆转普罗帕酮的抗室上性心动过速效应

30例持续性(＞2分)室上速(SVT),在普罗柏酮(Pro)静注后和加用异丙肾上腺素(Iso)静滴时行食管内心脏电生理研究。Iso对Pro抗SVT效应的完全和部分逆转率分别为57％(16／28例)和18％(5／28例)．16例随访期间服用Pro,5例有SVT临床复发,其中4例为Iso对Pro抗SVT效应有完全逆转作用者,加用美托洛尔后未再复发。4例Iso对Pro抗SVT效应无逆转作用者均无临床复发。     

异丙肾上腺素对室上性心动过速的诊断价值

折返性心动过速临床较为常见,主要有窦房结、心房内、房室结内、房室和心室内折返性心动过速等。房室旁道的存在和房室双径路及多径路或房室旁道伴双径路、多径路及多种附加束同时存在时,不一定都发生折返性心动过速。本文通过静脉滴注异丙肾上腺素提高患者心率,并刺激心房引发心动过速以明确诊断。     

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。     

异丙肾上腺素依赖性左侧旁路诊断及射频消融1例

患者 ,女 ,36岁。因反复胸闷、心悸 2 0余年 ,加重 5年入院。严重发作多在紧张、活动时 ,出现晕厥、大汗、脸色苍白、呼吸困难等。当地心电监护心电图示室上性心动过速 ,用毛花苷C或维拉帕米可终止。次日在我院行电生理和射频消融术 ,常规心内放置高右房、冠状窦、希氏束、右心室电极。行右心室S1 S1 刺激 ,S1 S1 =5 0 0ms时VA呈 2∶1传导 ,希氏束A波最早 ,未诱发心动过速。行高右房S1 S2 刺激 ,S1 S2 =5 0 0 / 4 5 0～ 2 1 0ms时 ,无AH跳跃 ,未诱发心动过速。行高右心房S1 S2 S3=5 0 0 / 4 5 0 / 4 5 0～ 2 2 0ms刺激时 ,无AH跳跃 …     

异丙肾上腺素对射频消融房室结折返性心动过速疗效…

地消融房室结慢径的７２例房室结折返性心动过速（ＡＶＮＲＴ）病人进行观察分析，以了解异丙肾上腺素在ＡＶＮＲＴ射频消融中的临床价值。消融前电生理检查时有２７．８％（２０／７２）从未能诱发ＡＶＮＲＴ，静脉滴注异丙肾上腺素后，８５．０％（１７／２０）则能诱发；消融后４７．９％（３４／７２）和异丙肾上腺素评价，其中９例既有吉跳跃现象又有心房回波的病人５０．０％（４／８）诱发出ＡＶＮＲＴ而重新消融。随访８．５     

异丙肾上腺素对射频消融房室结折返性心动过速疗效评价的意义

对消融房室结慢径的７２例房室结折返性心动过速（ＡＶＮＲＴ）病人进行观察分析，以了解异丙肾上腺素在ＡＶＮＲＴ射频消融中的临床价值。消融前电生理检查时有２７．８％（２０／７２）的病人未能诱发ＡＶＮＲＴ，静脉滴注异丙肾上腺素后，８５．０％（１７／２０）则能诱发；消融后４７．９％（３４／７２）用异丙肾上腺素评价，其中８例既有房室结跳跃现象又有心房回波的病人５０．０％（４／８）诱发出ＡＶＮＲＴ而重新消融。随访８．５±４．３个月，成功消融的７１例中，３４例经异丙肾上腺素评价者无一例复发，３７例未用异丙肾上腺素评价者２例复发。提示静脉滴注异丙肾上腺素可提高ＡＶＮＲＴ的诱发率；消融后房室结慢径前传功能存在时，无论有无心房回波均应用异丙肾上腺素评价，以确定消融终点和降低复发率。     

Successful treatment of paroxysmal supraventricular tachycardia with MAST

We have noted that inflation of the military antishock trousers (MAST) successfully converted five of six patients with paroxysmal supraventricular tachycardia to normal sinus rhythm. In all patients the usual "vagal" maneuvers were tried first and were unsuccessful. MAST inflation may be a safe and useful addition to the traditional vagal maneuvers used to treat paroxysmal supraventricular tachycardia.     

Electrophysiological characteristics and catheter ablation in patients with paroxysmal supraventricular tachycardia and paroxysmal atrial fibrillation

Introduction: Paroxysmal supraventricular tachycardia (PSVT) is often associated with paroxysmal atrial fibrillation (AF). However, the relationship between PSVT and AF is still unclear. The aim of this study was to investigate the clinical and electrophysiological characteristics in patients with PSVT and AF, and to demonstrate the origin of the AF before the radiofrequency (RF) ablation of AF.
Methods and Results: Four hundred and two consecutive patients with paroxysmal AF (338 had a pure PV foci and 64 had a non-PV foci) that underwent RF ablation were included. Twenty-one patients (10 females; mean age 47 ± 18 years) with both PSVT and AF were divided into two groups. Group 1 consisted of 14 patients with inducible atrioventricular nodal reentrant tachycardia (AVNRT) and AF. Group 2 consisted of seven patients with Wolff-Parkinson-White (WPW) syndrome and AF. Patients with non-PV foci of AF had a higher incidence of AVNRT than those with PV foci (11% vs. 2%, P = 0.003). Patients with AF and atypical AVNRT had a higher incidence of AF ectopy from the superior vena cava (SVC) than those with AF and typical AVNRT (86% vs. 14%, P = 0.03). Group 1 patients had smaller left atrial (LA) diameter (36 ± 3 vs. 41 ± 3 mm, P = 0.004) and higher incidence of an SVC origin of AF (50% vs. 0%, P = 0.047) than did those in Group 2.
Conclusion: The SVC AF has a close relationship with AVNRT. The effect of atrial vulnerability and remodeling may differ between AVNRT and WPW syndrome.     

Radiofrequency catheter ablation for paroxysmal supraventricular tachycardia: a report of 135 procedures

Background: Paroxysmal Supraventricular Tachycardia (PSVT) is a common condition which until recently has been treated with anti-arrhythmic drugs or surgery. Radiofrequency (RF) catheter ablation is a new mode of treatment which provides a cure of this condition. Aims: To present our early experience of RF catheter ablation for PSVT. Methods: One hundred and thirty-five procedures were performed in 117 patients. The diagnostic study and therapeutic catheter ablation were performed as a combined electrophysiological procedure in 74 patients (63%). In 58 patients (50%), PSVT was due to Atrio-ventricular junctional (nodal) re-entrant tachycardia (AVJRT). Twenty-five of the 58 patients underwent a fast pathway ablation while 33 had ablation of their slow pathway. The mean number of radio-frequency pulses delivered was ten for a mean duration of 25 seconds. Radiofrequency ablation of accessory pathways was attempted in 58 patients; pathways were left-sided in 29 patients, postero-septal in 21, midseptal in five, Mahaim connection in two, antero-septal in one and right free wall in one patient. One patient with incessant automatic atrial tachycardia also underwent a successful RF ablation. Results: Using RF ablation cure of PSVT was achieved in 90% of patients. Cure of AVJRT was achieved in 95% (55/58) of patients using either fast or slow pathway ablation. Only one patient required permanent pacemaker implantation for Mobitz type I AV block following fast pathway ablation. The overall success rate for ablation of accessory pathways was 85%. There is an operator learning curve for this procedure suggested by the fact that the success rate for accessory pathway ablation at first attempt was 63% in the first 29 patients and 93% in the remaining 29. There was no significant morbidity or mortality during or after the procedure. In a mean follow-up of nine months in the patients with successful ablation only two patients with AVJRT had a recurrence of documented PSVT. Both these patients had successful repeat RF ablation. Catheter ablation using radiofrequency energy is an effective and safe therapeutic option for patients with symptomatic PSVT. (Aust NZ J Med 1993; 23: 317–324.)     

Carto3在指导阵发性室上性心动过速射频消融术中的应用

目的总结阵发性室上性心动过速(PSVT)射频消融治疗病例,比较应用三维电解剖标测系统Carto3指导PSVT导管消融的疗效及安全性,着重分析永久性Ⅱ°以上房室传导阻滞(AVB)的发生率。方法自1992年1月1日至2017年12月31日间,联勤保障部队第980医院心血管内科共完成PSVT导管消融治疗且资料齐全的病例2098例。使用Carto3前称为二维组,使用Carto3后称为三维组,比较使用Carto3指导PSVT导管消融的疗效及安全性,着重分析永久性Ⅱ°以上AVB的发生率,总结发生AVB的病例特点,分析相关因素。结果共完成PSVT导管消融治疗病例2098例,其中发生永久性Ⅱ°以上AVB 5例,发生率0.24%。二维组1443例,发生永久性Ⅱ°以上AVB 5例,发生率0.35%;三维组655例,未发生永久性Ⅱ°以上AVB。发生AVB的病例中,房室结折返性心动过速2例,后间隔部旁道2例,希氏束旁旁道1例。发生AVB时消融术者手术年限情况:二维时代术者2名,发生并发症时术龄分别是7年和15年,三维时代术者2名,发生并发症时术龄分别是1年和3年。结论间隔部旁道消融和房室结慢径改良有发生AVB的风险,应用三维标测系统指导阵发性室上速消融治疗可显著降低永久性房室传导阻滞的发生风险。     

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。     

Differential effects of sotalol and metoprolol on induction of paroxysmal supraventricular tachycardia

Seventeen patients with recurrent paroxysmal supraventricular tachycardia (SVT) underwent serial electrophysiologic studies to compare the effects of i.v. sotalol (1.5 mg/kg) and i.v. metoprolol (0.15 mg/kg). The plasma concentrations of sotalol (2.1 ±1.1 μg/ml) and metoprolol (67 ± 15 ng/ml) were within the therapeutic range. Before drug administration, sustained SVT could be reproducibly induced in all patients. Sotalol prevented induction of sustained SVT in 10 of 17 patients (59%) and metoprolol in 4 (28%) (p < 0.05). In 6 of 8 patients with atrioventricular (AV) nodal reentrance, the site of action of sotalol was the anterograde or the retrograde limb, reflecting an increase in refractoriness in both pathways of the circus movement. In 4 of 9 patients with AV reentrance, the site of action of sotalol was exclusively the AV nodal pathway; conduction through the extranodal accessory tract appeared to be unchanged, but lts anterograde effective refractory period was prolonged (from 285 ± 25 to 322 ± 28 ms, p <0.001; mean ± Standarddeviation). In the 7 patients in whom sotalol did not prevent sustained SVT, the tachycardia cycle length increased from 347 ± 42 to 392 ± 45 ms (p <0.01). Compared with sotalol, metoprolol had qualitatively similar but quantitatively less potent effects on the AV nodal pathways; however, different from sotalol, metoprolol had no effect on extranodal accessory tracts.The study suggests that at therapeutic plasma concentrations, sotalol would be effective in preventing clinical SVT in a significant proportion of patients refractory to metoprolol; because sotalol not only has β-blocking properties but also results in acute prolongation of the action potential duration, this combination of class II and III activity may contribute to its superior prophylactic efficacy compared with pure β blockade.