食管心房调搏诱发与终止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与终止房室折返性心动过速的价值。方法选择255例有心动过速发作史,并且既往心电图证实有阵发性室上性心动过速(PSVT)的患者行食管心房调搏检查。结果在被检的255例患者中诱发房室折返性心动过速229例,占89.8%(其中顺向型217例,占94.8%,逆向型12例,占5.2%)。诱发成功的最佳刺激方法为程序期前刺激法(S1S2、S1S2S3),诱发率为88.2%。诱发的必备条件是旁路有效不应期长于房室结有效不应期。在诱发房室折返性心动过速的229例中215例经电刺激成功终止,转复为窦性心律,成功率为93.9%,其中64例采用短阵快速刺激一次性成功终止,转复成功率达100%。结论食管心房调搏能有效地诱发与终止房室折返性心动过速,诱发顺向型房室折返性心动过速的关键因素是旁路不应期大于房室结有效不应期,终止发作的最有效的刺激方法为短阵快速刺激。本法可作为急诊终止阵发性室上性心动过速的首选方法。

The study of evocation and termination of reentry tacbycardia by trans-esophageal atrial pacing

Objective To investigate the value of evocation and termination of reentry tachycardia by trans-esophageal atrial pacing.Methods 255 patients who had paroxysmal supraventricular tachycardia(PSVT) documented by ECG were included and received trans-esophageal atrial pacing.Results The reentry tachycardia were evocated in 229 patients(89.9% of total),and there were 217 cases(94.8%) of orthodromic atrioventricular reentry tachycardia and 12(5.2%) cases of anisotropy reentry tachycardia.The best method to evocated the reentry tachycardia was programmed premature stimulation(PES) with S1S2 or S1S2S3 and the 88.2% reentry tachycardia were evocated by this method.The effective refractory period(ERP) of accessory pathway,which was the essential condition of evocation,was longer than that of atrioventricular node.215 cases of 229 reentry tachycardia patients were terminated by electrical stimulation,the success rate was 93.9%.64 cases were terminated by burst stimulation and the success rate was 100%.Conclusion Trans-esophageal atrial pacing can evocate and terminate reentry tachycardia effectively.ERP of accessory pathway longer than that of atrioventricular node is a key factor of orthodromic atrioventricular reentry tachycardia evocation.The most effective method to terminate the reentry tachycardia is burst stimulation which can be used to terminate the paroxysmal supraventricular tachycardia as a emergency method.