射频导管消融慢径路治疗程控刺激不能诱发且无明显跳跃的房室结折返性心动过速疗效分析

目的观察无A—H间期跳跃和不能诱发的房室结折返性心动过速（AVNRT）慢径路消融特点和远期疗效。方法经电生理检查证实无旁道参与的阵发性室上性心动过速患者100例，分成三组：能诱发AVNRT，有明显跳跃（A组，n=40）；不能诱发AVNRT，但有A—H间期〉50ms的明显跳跃（B组，1=40）；不能诱发AVNRT且没有A—H间期〉50ms的明显跳跃（C组．n=20）。比较术后各组电生理数值及消融远期疗效。结果与消融术前相比．术后各组患者的房室结顺传文氏周期均延长（P〈0．05）；消融术后房室结顺传有效不应期较术前缩短，差异有统计学意义（P〈0．05）；三组均出现缓慢交接区心律。术后随访12个月．各组复发率差异无统计学意义（P〉0．05）。结论无A—H间期跳跃且程控刺激不能诱发的AVNRT的慢径路消融是安全有效的。缓慢交接区心律是消融有效的标志。

Ablation of Slow Pathway of Atrioventricular Nodal Reentrant Tachycardia without AH Jump and Supraventricular Tachycar- dia during Programmed Stimulation

Objective To assess features of slow pathway ablation and long-term efficacy of atrioventricular nodal reentrant tachycardia（AVNRT） without AH jump and tachycardia onset during programmed stimulation. Methods Based on electrophysiological test results, 100 patients with paroxysmal supraventricular tachycardia and no bypass pathway were divided into group A, AH jump followed by AVNRT onset（n,=40）, group B, AH jump but no AVNRT（n=40 ）, and group C, no AH jump and no ANVRT （.=20）. Electrophysiological parameters and long-term efficacy were compared between groups. Results AV nodal antegrade conduction Wenckebach periods were prolonged significantly in all patients after ablation （P〈0.05）. The effective refractory period of AV node shortened significantly after ablation （P〈0.05）. Junctional rhythm appeared during ablation in all patients. The recurrence rate was similar in all groups during follow-up 12 months. Conclusion Slow pathway ablation is safe and effective for AVNRT without AH jump and inducible tachycardia during programmed stimulation. Junctional rhythm is a marker of effective ablation.