心动过速RR间期交替的发生机制及导管射频消融治疗

目的　分析QRS心动过速伴RR间期长短交替的发生机制及导管射频消融情况。方法　对 6例心动过速伴RR间期长短交替患者 ,常规行动态心电图及食管电生理检查。心内电生理检查提示存在房室旁路或房性心动过速伴房室结双径路 ,先进行旁路或房性心动过速的消融 ,消融成功后再进行心内电生理检查 (包括应用异丙肾上腺素进行心动过速诱发 ) ,如不能诱发心动过速则终止手术。若提示存在房室结多径路 ,则进行慢路径改良术。结果　食管电生理检查提示 :4例患者存在房室旁路伴房室结双径路 ;2例患者存在房室结三径路。心内电生理检查及消融结果显示 :3例患者为房室旁路伴房室折返性心动过速 ,成功消融后不能诱发房室结折返性心动过速 ;1例患者同时存在房室及房室结折返性心动过速 ,成功消融房室旁路后再改良慢路径 ;2例患者为房室结三径路 ,经慢径路改良后房室结传导曲线连续 ,未诱发心动过速。 6例患者无并发症发生 ,随访期间无心动过速发作。结论　室上性心动过速伴RR间期交替发生率较低 ,且均与房室结传导不连续有关。心动过速伴RR间期交替发生机制较为复杂 ,除了与房室结纵向传导的不连续有关外 ,还与其不应期密切相关。食管电生理检查与心内电生理检查相比对揭示RR间期交替的发生机制具有较高的诊断价值。

The mechanisms and radiofrequency catheter ablation of tachycardia with R-R interval alternates

Objective To analyze the mechanisms and radiofrequency catheter ablation of 6 cases of tachycardia with R R interval alternates Methods We selected 6 patients with paroxysmal tachycardia and R R interval alternation After examination of electrocardiogram and Holter electrocardiogram, electrophysiologic study (EPS) was performed, which demonstrated to be atria ventricular reentrant tachycardia (AVRT) or atria ventricular nodal reentrant tachycardia (AVNRT) Furthermore, we ablated the accessory pathway or the origination of atria tachycardia If AVNRT was demonstrated, the slow pathway would abolish them Results Trans esophagus electrophysiologic study showed as follows: four patients had both AVRT and AVNRT Two patients had triple pathway in the atria ventricular node EPS and RFCA then demonstrated as follows Three patients had AVRT combined with AVNRT, and AVNRT could not be induced after accessory pathways were ablated One patient had both AVRT and AVNRT Two cases with triple AVNRT After ablation of the slow area, the conduction curves were continuous and no arrhythmias were induced There was no complication within 6 cases, no arrhythmias in follow up Conclusion R R interval alternates are rarely found in paroxysmal supraventricular tachycardia, and their onset is correlated with the discontinuity of atria ventricular node conduction The mechanisms of R R interval alternates are sophisticated; it is correlated with not only the discontinuity of atria ventricular nodal longitudinal conduction, but also the refractory period Trans esophagus electrophysiological study is valuable compared with endocardial electrophysiological study