房室旁路射频导管消融术中心脏记忆现象的分析

目的对房室旁路射频导管消融术(以下简称消融术)前后T波改变进行分析，以揭示影响T波改变的因素。 方法选择资料完整的显性房室旁路患者120例，隐匿房室旁路100例，所有患者均为单支房室旁路，术中旁路均阻断成功，男性170例，女性50例，年龄8～72(平均36±13)岁，均有术前及术后即刻同步十二导联心电图，显性房室旁路预激程度足够充分(预激波清晰，QRS波时限大于100ms)。按常规旁路消融方法，计算不同部位的显性及隐匿房室旁路消融术前后发生T波改变的百分率，比较不同部位显性房室旁路消融术前后发生T波改变的差异性，比较显性与隐匿房室旁路消融术前后发生T波改变的差异性。 结果不同部位的显性房室旁路消融术后发生T波改变无显著差异(右后侧壁100%，右后间隔100%，右侧其它部位93%，左后间隔100%，左侧其它部位90%，P＞0.05)，显性房室旁路与隐匿房室旁路(左侧隐匿房室旁路2%，右侧隐匿房室旁路20%)相比有非常显著差异(P＜0.01)。 结论消融术后发生T波改变是由于心脏记忆所致，与旁路部位、心肌损伤及自主神经功能变化无关，冠状动脉缺血不是显性房室旁路消融术后发生T波改变的主要原因。

Evaluation of Cardiac Memory after Ablation of Accessory Pathway

Objective:To assess factors leading to T wave change before and after ablation of accessory pathway. 　　Methods:The patient population comprised of 170 males and 50 females aged from 8 to 72(average 36±13),120 of them were with overt accessory pathways and 100 with concealed pathways,they all had single pathway,and were ablated successfully.Twelve lead ECGs before and after ablation was recorded and analysed.The percentage of T wave change among manifesting and concealed pathways as well as two groups with different ablation target sites before and after ablation were compared. 　　Results:There is no significant difference among those with overt accessory pathway(right posterior free wall,right posterior septal,other localization of right annula,left posterior septal,other localization of left annula was 100%,100%,93%,100%,90%,respectively,p＞0.05),but there is significant difference between those with overt and concealed pathways(p＜0.01). 　　Conclusion:The mechanism of T wave change after ablation is cardiac memory,and may not correlate with the localization of accessory pathway,myocardial trauma and the alteration of autonomic nervous system.