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。

Value of Para-Hisian pacing in distinguishing concealed septal pathway from slow-fast atrioventricular nodal reentrant tachycardia

Objective: To investigate the value of Para-Hisian Pacing in distinguishing concealed septal pathway from slow-fast atrioventricular nodal reentrant tachycardia(AVNRT). Methods: All 61 patients were devided into 37 patients with slow-fast AVNRT and 24 patients with atrioventriular reentrant tachycardia(AVRT) using concealed septal accessory pathway by ventricular extra-stimuli during tachycardia and His bundle refractory. All 61 patients underwent invasive electrophysiological studies, including Para-Hisian Pacing methods. Results: During Para-Hisian Pacing, 31/37 AVNRT show retrograde atrial activation only from atrioventricular node (retrograde from atrioventricular node map); 15/24 AVRT (septal pathway) observed retrograde atrial activation only from pathway (retrograde pathway/ pathway map). 5/24 AVRT (septal pathway) displayed non-retrograde pathway/ pathway map. Para-Hisian Pacing method was performed unsuccessfully in 6/37 AVNRT and 4/24 AVRT with septal concealed pathway. Para-Hisian Pacing (with retrograde pathway/ pathway map as distinguishing standard) can distinguish AVRT using concealed septal fast pathway from slow-fast AVNRT, sensitivity 75%, specificity 100%. Conclusions: Para-Hisian Pacing can diagnose AVRT (septal pathway) and distinguish AVRT using concealed septal fast pathway from slow-fast AVNRT with very high specificity.