房室结改良时发生完全性房室阻滞的特征性心电改变

探讨经导管射频消融 (RFCA)治疗房室结折返性心动过速 (AVNRT)时发生完全性房室阻滞 (Ⅲ度AVB)前的特征性心电改变。回顾分析自 1996年 1月至 1999年 12月RFCA治疗AVNRT放电过程有完整心内电图记录者 486例。放电过程中有室房 (VA)阻滞、快速交界心律 (≥ 16 0bpm)和 /或房室 (AV)阻滞称为特征性心电改变。Ⅰ组 387例 ,任何一次放电过程中无特征性心电改变 ;Ⅱ组 99例 ,有一次或一次以上放电过程中有特征性心电改变。Ⅱ组中有特征性心电改变的放电共 316次 ,即刻停止放电组 (Ⅱa组 ) 2 19次 ,指发现特征性心电改变后 2s以内停止放电 ;延迟停止放电组 (Ⅱb组 ) 97次 ,指发现特征性心电改变 2s后停止放电。结果 :①AVNRT消融总成功率 97.9%(4 76 /4 86 ) ,永久性Ⅲ度AVB 0 .41% (2 /4 86 )。②特征性心电改变中VA阻滞占 72 .5 % (2 2 9/316 )、快交界心律占2 0 .6 % (6 5 /316 )、AV阻滞占 7.0 % (2 2 /316 )。③Ⅲ度AVB(包括一过性和永久性 )发生率为 2 .3% (11/4 86 ) ,其中Ⅰ组为 0 (0 /387)、Ⅱ组为 11.1% (11/99) ,P <0 .0 0 0 1。④Ⅱa组Ⅲ度AVB发生率为 0 .9% (2 /2 19)、Ⅱb组Ⅲ度AVB发生率为 9.3% (11/97) ,P <0 .0 0 1。RFCA改良房室结治疗AVNRT时Ⅲ度AVB均发生在特征性心电改变之后 ,发现特征?

Endocardial Electrogram Predictors of Complete Atrioventricular Block During Energy Delivery in Radiofrequency Catheter Ablation for Atrioventricular Nodal Reentrant Tachycardia.

In order to examine the endocardial electrogram predictors of complete atrioventricular block (Ⅲ°AVB) during energy delivery in radiofrequency catheter ablation (RFCA) for atrioventricular nodal reentrant tachycardia (AVNRT), the intact endocardial electrogram data in 486 patients who underwent RFCA of AVNRT from January 1996 to December 1999 were analyzed retrospectively.Endocardial electrogram predictors were defined as ventriculoatrial (VA) block,fast junctional rhythm (≥160 beats per min) and/or atrioventricular (AV) block during delivery of radiofrequency energy.Group Ⅰ included 387 patients without endocardial electrogram predictors and group Ⅱ included 99 cases with endocardial electrogram during once or more application of radiofrequency current.Endocardial electrogram predictors occurred 316 times,in which radiofrequency energy was discontinued within 2 seconds in 219 (group Ⅱa) and more than 2 seconds in 97 (group Ⅱb).Results: ①Total success rate was 97.9% (476/486) and permanent Ⅲ°AVB occurred in two patients (0.41%);②There were 229 times (72.5%) of VA block,65 times (20.6%) of fast junctional rhythm and 22 times (7.0%) of AV block in the 316 times of endocardial electrogram predictors;③The combination incidence of transient and permanent Ⅲ°AVB was 2.3% (11/486).Group Ⅱ had a higher incidence of Ⅲ°AVB than group Ⅰ (11.1% vs 0%, p<0.01 ).④The incidence of Ⅲ°AVB in group Ⅱa (2/219,0.9%) was higher than that in group Ⅱb (9/97,9.3%;p<0.001).In conclusion,Ⅲ°AVB had its characteristic endocardial electrogram predictors and its incidence could be markedly reduced if the energy delivery discontinued immediately once the endocardial electrogram predictors occurred.[Chinese Journal of Pacing and Electrophysiology,2000,14(3):159～163]