腺苷终止房室结和房室旁道折返性心动过速的心内电生理评价

探讨腺苷对阵发性室上性心动过速 (PSVT)的终止效果 ,观察PSVT终止后出现的心律失常。 2 5例患者 ,其中房室结折返性心动过速 (AVNRT) 11例、房室折返性心动过速 (AVRT) 14例 ,于心内电生理检查时 ,由前臂静脉注射(简称静注 )腺苷 6～ 12mg ,观察其终止心动过速的疗效和作用部位。结果 :11例AVNRT患者静注腺苷后 ,10例恢复窦性心律 ,其中 9例终止AVNRT于慢径前传 ,1例于快径逆传 ;14例AVRT患者静注腺苷后 ,14例均恢复窦性心律 ,终止AVRT 12例于房室结前传 ,2例于旁道逆传。心动过速终止后最常出现的心律失常是房性早搏和一过性Ⅰ和Ⅱ度房室阻滞 ;此外 ,室性早搏也很常见 ,部分患者可出现短阵室性心动过速 ,1例患者出现预激综合征伴心房颤动。结论 :腺苷终止PSVT有较高的成功率 ,但有潜在的促心律失常作用。

Electrophysiologic Effects of Adenosine in Termination of Supraventricular Tachycardia

To study the electrophysiologic(EP) effects of adenosine and tachycardia termination mechanism in patients with paroxysmal supraventricular tachycardia(PSVT),adenosine was administered to 25 patients with PSVTs during EP study: typical atrioventricular(AV) nodal reentrant tachycardia(AVNRT, n=11), atrioventricular reentrant tachycardia(AVRT, n=14). Results:A total of 10 patients with typical AVNRT showed tachycardia termination after adenosine, 9 of 10 (90%) patients terminated with antegrade slow pathway block, whereas 1 of 10(10%) terminated in the retrograde fast pathway. AVRT showed tachycardia termination antegradely in the AV node in 12 patients (12/14 or 86%) and in 2 patients (2/14 or 14%) retrogradely in the accessory pathway. After PSVT termination atrial or ventricular premature complexes occurred in 42% and 33% patients,respectively.Transient I and II degree AV block were commonly observed.One patient has preexcited atrial fibrillation after AVRT termination. Conclusions:Adenosine was effective in termination of PSVT and it had potential proarrhythmia.