三磷酸腺苷终止阵发性室上性心动过速的疗效观察

目的探讨三磷酸腺苷治疗阵发性室上性心动过速的有效率。方法对59例经心电图证室正在发作的阵发性室上性心动过速患者快速静脉注射三磷酸腺苷10～20mg,观察其有效率。结果 56例成功复律,总有效率达89.8%。结论三磷酸腺苷终止阵发性室上性心动过速方便、快捷、经济、有效率高。     

三磷酸腺苷终止室上性心动过速的研究

三磷酸腺苷（ＡＴＰ）终止室上性心动过速（ＳＶＴ）时，在ＳＶＴ终止后到稳定的窦性心律出现之前常出现房室阻滞、窦性停搏等一过性心律失常。少数患者ＳＶＴ发作时ＡＴＰ无效，但可在用药后出现一过性心律失常。本文旨在探讨识别ＡＴＰ对ＳＶＴ有效的判别标志，并寻找防止或减轻ＡＴＰ可能引起的一过性心律失常的方法。　　资料和方法　对４９例，６９例次使用ＡＴＰ２０ｍｇ快速静脉注射终止ＳＶＴ的试验资料和临床资料，按ＳＶＴ发作时心率分组。发作时心率≥１６０ｂｐｍ者分入甲组，发作时心率＜１６０ｂｐｍ者分入乙组。规定静脉注射…     

三磷酸腺苷终止阵发性室上性心动过速时心电图改变4例

三磷酸腺苷(ATP)半衰期短、代谢快、副作用小,已成为终止阵发性室上性心动过速的一线药。但在一些病人的复律过程中出现较长的窦性停搏及不同程度的心律失常。本文报道4例用心电图连续监测ATP复律前后的心律(率)变化(图1～图4),探讨其的电生理效应及特点。图2患者男性,66岁。阵发性心悸13年,再发6h入院。A.心率166次/min,P-波位于QRS波群之后,P--R间期>R-P-间期,诊断为顺向性房室折返性心动过速。立即肘静脉弹丸式注射ATP20mg。注射完毕2s室上性心动过速终止,出现两次窦性激动后出现一室性期前收缩,期前收缩后可见长达9.06s的窦性停…     

三磷酸腺苷和异搏定终止阵发性室上性心动过速的对比观察

本文用ATP和异搏定终止24例FSVT,比较两药的有效性、电生理效应和副作用。结果显示:虽然西药主要作用都在房室结,但两药复律方式、电生理效应有差异;终止FSVT两药疗效相似(P>0.05),ATP复律快(P<0.05),而异搏定复律过程平稳且复律后心律失常发生率低(P<0.05)。     

静脉注射三磷酸腺苷终止阵发性室上性心动过速有效剂量的探讨

目的　对符合诊断的 46例具有阵发性室上性心动过速 (paroxysm al supraventriculartachycardia,PSVT)的患者 ,经周围静脉注射三磷酸腺苷 (adenosine triphosphate,ATP) ,探讨其终止心动过速的有效剂量。　方法　通过食管起搏或心内电生理检查的方法诱发心动过速。以肘静脉为给药部位 ,以 0 .0 5 0 mg· kg- 1为起始剂量 ,以 0 .0 2 5 m g· kg- 1为递增量 ,用药剂量直至 PSVT终止或因症状较重而不能忍受。　结果　终止本组心动过速所需 ATP最小有效剂量为 0 .0 5 0 mg· kg- 1 ,最大剂量为0 .2 0 0 mg· kg- 1 ,终止全部心动过速所需 ATP剂量平均为 0 .118mg· kg- 1 ,95 %的可信区间为[0 .0 35 ,0 .2 0 2 ]。终止过程有轻度的胸部压迫感、乏力、头晕等症状 ,所有患者均无晕厥发生。　结论　采用个体化的用药方法 ,以 0 .15 0 mg· kg- 1为起始剂量的 ATP终止 PSVT的有效率为 82 .6 % ,效果好且没有明显的副作用 ,故推荐采用以此剂量为起始的递增用药方法终止心动过速     

三磷酸腺苷终止室上性心动过速疗效及安全性

目的观察三磷酸腺苷快速静脉注射终止阵发性室上性心动过速的疗效及安全性。方法对46例次阵发性室上性心动过速患者快速静脉注射三磷酸腺苷10mg～20mg，2秒钟～3秒钟内完成，观察5分钟，未终止者重复用10mg～20mg，仍然未终止者每间隔5分钟再重复用2次，用药前、用药终止时记录血压、心率及十二导联静息心电图，用药过程全程监测心电情况。结果46例次转复成功44例次，转复成功率95．7％，无严重并发症发生。结论ATP快速静脉注射终止阵发性室上性心动过速疗效确切、快速、安全。     

小剂量三磷酸腺苷快速静脉注射终止阵发性室上性心动过速的效果观察

目的观察小剂量三磷酸腺苷快速静脉注射终止阵发性室上性心动过速(PSVT)的效果。方法选取入我院进行治疗的PSVT患者54例,将其随机分为研究组和对照组,各27例。研究组采取三磷酸腺苷10mg快速静脉注射,然后快速静脉注射5%葡萄糖注射液20ml,如果5min内不能终止,则增加剂量;如果无效,采取其他措施。对照组采用常规剂量进行治疗,取三磷酸腺苷20mg快速静脉注射。结果研究组使用三磷酸腺苷的总有效率为92.6%,对照组使用三磷酸腺苷的总有效率为85.2%,两组比较差异无统计学意义(P>0.05);静脉注射10min内研究组患者窦性停搏、室性异搏及呼吸困难发生率低于对照组,差异有统计学意义(P<0.05)。结论小剂量快速静脉注射三磷酸腺苷终止PSVT的效果较好,起效时间快,不良反应轻。     

小剂量三磷酸腺苷治疗阵发性室上性心动过速临床观察

目的观察小剂量三磷酸腺苷（ATP）治疗阵发性室上性心动过速（PSVT）的疗效及不良反应,探讨小剂量ATP治疗PSVT的价值。方法82例急诊PSVT患者,随机分成2组。小剂量ATP组45例,给予ATP0．1mg／kg快速静脉注射,随即给予20ml生理盐水快速静脉注射。普罗帕酮组37例,给予70懈普罗帕酮静脉注射。结果小剂量ATP组复律38例,普罗帕酮组复律31例,两组比较差异无统计学意义（P〉0．05）,但前者复律时间明显短于后者（P〈0．01）。ATP组7例未复律者,经使用普罗帕酮复律。普罗帕酮组6例未复律者,2例经刺激迷走神经而复律,另4例经重复使用普罗帕酮而复律。ATP组不良反应发生率高于普罗帕酮组（P〈0．05）,但不良反应短暂而轻微。结论小剂量ATP治疗PSVT的有效率与普罗帕酮相当,虽然不良反应发生率较高,但短暂而轻微,具有复律时间短、不影响后续抗心律失常药物使用的优点。     

Adenosine triphosphate and adenosine: perspectives in the acute management of paroxysmal supraventricular tachycardia

Adenosine triphosphate (ATP) and adenosine exert strong and transient depressant effects on the sinoatrial and atrioventricular (AV) nodes of the human heart. The AV nodal effects of these drugs explain their high efficacy in either terminating AV re-entrant supraventricular tachycardia or in slowing ventricular rate during atrial tachyarrhythmias. Their very short half-life enables repeated administration of increased doses without reaching toxic effects and explains the transient character of their frequent but benign side effects. These agents represent a good alternative to verapamil in the acute management of paroxysmal supraventricular tachycardia both in infants and adults.     

Pirmenol in termination of paroxysmal supraventricular tachycardia

An assessment was made of the effect of pirmenol in the termination of paroxysmal supraventricular tachycardia (SVT). Sinus rhythm was restored by intravenous administration in 11 of 17 patients during a spontaneous attack. Another 8 patients were studied electrophysiologically. Pirmenol terminated an induced SVT in 3 of 5 patients having an atrioventricular (AV) intranodal re-entry mechanism but in none of 3 patients having an atrioventricular bypass tract as one re-entrant limb. The overall success in restoring sinus rhythm was 14 of 25 patients (56%). The drug was hemodynamically well tolerated even in cases of continued SVT. Pirmenol increased the atrial effective refractory period and had no obvious effect on AH and HV intervals. The functional refractory period of the AV node was decreased, probably by an anticholinergic effect. The effective and functional refractory periods of retrograde atrioventricular conduction via the AV node and bypass tract were increased in some patients. The mechanism terminating the AV intranodal SVT was a block in the retrograde part of the dual AV nodal pathway, a typical antiarrhythmic Class I effect.     

ATP对室上性心动过速患者窦房结和房室结功能的影响

对30例室上速患者用食管心房调搏诱发SVT110例次,观察不同剂量的ATP(10mg、20mg、30mg)在终止SVT过程中对窦房结和房室结功能的影响。发现ATP对窦房结和房室结有负性变率和负性传导作用,且随ATP用量的增加而加重。以ATP治疗室上速有一定风险,不宜作为首选药物。     

Comparison of adenosine effects on atrioventricular node reentry and atrioventricular reciprocating tachycardias

Background: Adenosine is an established first line therapy for the treatment of narrow complex tachycardias. The two most common etiologies of paroxysmal supraventricular tachycardia (SVT) are atrioventricular node reentry tachycardia (AVNRT) and atrioventricular reciprocating tachycardia (AVRT). Hypothesis: We postulated that adenosine might have different effects on the termination of AVNRT vs. AVRT, and that these differences might assist in the noninvasive differentiation between these diagnoses. Methods: Fifty-nine patients referred for the diagnosis and treatment of SVT were included in the study. All patients had SVT induced during electrophysiology testing, and each patient received adenosine during SVT. The adenosine dose, time to tachycardia termination, and site of tachycardia termination were recorded. Seventeen patients required isoproterenol administration to initiate SVT. This subset of patients was compared with those not requiring isoproterenol. Results: There was no statistically significant difference in the adenosine dose or time to tachycardia termination when comparing patients with AVNRT with those with AVRT. All patients with AVNRT had termination of tachycardia in the antegrade direction with final activation in the atria. Patients requiring isoproterenol for tachycardia initiation experienced tachycardia termination significantly faster than those not requiring isoproterenol, although there was no difference in the dose of adenosine required for termination. Conclusion: These data demonstrate that patients with dual AV node physiology and AVNRT do not have altered sensitivity to adenosine compared with patients with AVRT and normal AV nodes. Further investigation will be required to determine the clinical utility of the significantly shorter time to tachycardia termination for patients receiving isoproterenol.     

心悸患者窦性心律时静脉注射三磷酸腺苷对室上性心动过速的诊断作用

目的 探讨窦性心律时静脉注射三磷酸腺苷(adenosine triphosphate，ATP)对病因不明的心悸患者诊断房室结折返性心动过速(atrioventricular nodal reentrant tachycardia，AVNRT)和房室折返性心动过速(atrioventricular reentrant tachycarclia，AVRT)的价值。方法 97例疑为室上性心动过速(SVT)的心悸患者，其中心悸发作时无心电图记录者33例，有心电图记录但机制不明者64例。在窦性心律时静脉注射递增剂量ATP(5～40mg)，全部受试者均接受心内电生理检查。结果 95例完成了研究，其中ATP试验阳性67例(70．5％)，包括出现房室结双径路(atrioventricular node dual pathway，AVNDP)征象者44例(46．3％)、出现隐匿性旁路(concealed accessory pathway)征象者23例(24．2％)。ATP试验对AVNRT或AVRT的阳性预测值为94％，敏感性为86.3％，阴性预测值为64.3％，特异性为81．8％。结论 窦性心律时静脉注射ATP对心悸患者AVNRT和AVRT的阳性预测值高，是判明心悸病因的一个有价值的诊断方法。     

Intravenous diltiazem for the treatment of supraventricular tachycardia

To determine the effects of diltiazem hydrochloride on patients with paroxysmal supraventricular tachycardia, we administered intravenous diltiazem, 0.25 mg/kg to patients who presented to the Stanford Medical Center Emergency Department with this rhythm. Blood pressure was recorded prior to administration, and monitored for 20 min thereafter. Six of the ten patients converted to sinus rhythm a mean of 7.75 min (+/- 4.4) after drug administration. The remaining four experienced slowing of heart rates from a mean of 177 to 166 beats/min. Systolic blood pressure fell a mean of 12.4 mmHg during treatment, but returned to pretreatment level or higher within 20 min following diltiazem administration. This mean degree of blood pressure reduction compares favorably with effects produced by intravenous verapamil under comparable circumstances. Intravenous diltiazem appears to be a safe and effective drug for the conversion of paroxysmal supraventricular tachycardia.     

The use of calcium gluconate prior to verapamil in infants with paroxysmal supraventricular tachycardia

Verapamil is a useful drug for treating supraventricular tachycardia; however, severe side effects occasionally have been reported in infants. We describe here our experience with the use of a 10 percent solution of intravenous calcium gluconate prior to the use of verapamil in infants with paroxysmal supraventricular tachycardia. In all the attacks verapamil converted the supraventricular tachycardia to sinus rhythm. We feel that calcium gluconate injected previous to verapamil can avoid the negative inotropic effects without interfering with the antiarrhythmic properties of verapamil.     

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。     

三维标测指导下的阵发性室上性心动过速射频消融

目的探讨与常规标测相比。三维标测指导下的阵发性室上性心动过速射频消融的可行性、安全性与优势。方法回顾性分析2013年1月至8月,在宁波市第一医院行射频消融术的阵发性室上性心动过速的患者114例,按照标测方法分为三维标测组与常规标测组,比较两组间的射频消融成功率、并发症发生率、手术时间、x线曝光时间与x线曝光量。结果两组所有手术均获得即刻成功,均无并发症发生。两组的手术时间比较,差异无统计学意义[（77．6±28．1）min vs.（70．4±23．2）min,P〉0．05]。三维标测组的x线曝光时间与x线曝光量均显著低于常规标测组（中位数：4．2minvs．15．4min,P〈0．01;中位数：11．0mGyvs76．7mGy,P〈0．01）,差异有统计学意义。结论阵发性室上性心动过速的射频消融术与常规标测相比,采用三维标测指导具有相同的成功率与安全性,并不延长手术时间,且能显著减少x线曝光时间与x线曝光量。