房室结折返性心动过速与冠状静脉窦关系的初步研究

为探讨房室结双径路导致折返性心动过速的发病机制，以更准确的选择消融靶点和减少并发症。对经电生理检查诊断的３３例室上性心动过速（ＳＶＴ）病人进行冠状静脉窦（ＣＳ）造影的对比研究。分为两组，其中房室结折返性心动过速（ＡＶＮＲＴ）组１７例，对照组（为其他室上性心动过速）１６例。两组病人均经ＣＳ造影，观察ＣＳ形态、走行及分支情况，测量ＣＳ口（ＣＳＯ）大小、窦体直径、长度及窦口上缘与Ｈｉｓ束之间的距离。结果发现ＡＶＮＲＴ组ＣＳ近端形态多呈漏斗状，占８２．４％，而对照组漏斗状仅占２５．０％，其余多呈管状（Ｐ＜０．０１）。ＡＶＮＲＴ组ＣＳＯ明显扩张，两组ＣＳＯ直径分别为１６．４±４．７和１０．２±３．９ｍｍ（Ｐ＜０．０１）。ＡＶＮＲＴ组窦口上缘到Ｈｉｓ束的距离明显较对照组近（８．０３±６．１２ｍｍｖｓ２１．３±６．４８ｍｍ），Ｐ＜０．００１。结果提示：ＡＶＮＲＴ患者的ＣＳＯ扩张对局部心房肌的压迫和牵拉，使ＣＳＯ周围的心房肌各向异性程度增高，可能是导致各向异性折返的病理机制。由于ＣＳＯ扩张使ＣＳＯ上缘距Ｈｉｓ束距离变近，给射频消融（ＲＦＣＡ）造成困难和危险，对此类ＡＶＮＲＴ病人行ＲＦＣＡ应谨慎从事。

A Preliminary Study on the Relationship Between Atrioventricular Nodal Reentrant Tachycardia and Coronary Sinus Morphology

Thirty-three patients,including 17 with atrioventricular nodal reentrant tachycardia (AVNRT) and 16 with other superventricular tachycardia (SVT),underwent electrophysiologic study and radiofrequency catheter ablation (RFCA).A coronary sinus (CS) venography was performed in each patient after RFCA.CS dimensions,morphology,branches and the distances from the upper and lower lips of CS ostium to the tip of the His bundle catheter were measured.The results demonstrated that the proximal CS had the appearance of funnel shapped in 83% of AVNRT group.While this morphology was observed only in 25% of the other group in which the coronary sinus was tubulur shaped.It had showed that CS ostium was dilatation significantly in AVNRT group.The mean ostium diameter was 16.4±4.7 mm in AVNRT group and 10.2±3.9 mm in control group,P<0.001.The mean distance from upper lip of ostium to His bundle is shorter in AVNRT group than that of the control group (8.03±6.12 mm vs 21.3±6.48 mm,P<0.001).The dilatation of the CS ostium in AVNRT patients might provide the substrate to gain anisortropy of atrial tissue near CS orifice and there upon might facilitate to establish an anisotropic reentrant tachycardia.Narrowed distance from upper lip of the coronary sinus ostium to tip of the His bundle catheter may cause difficulty and more risk of RFCA due to dilation of coronary sinus orifice.