房室结折返性心动过速患者房室结功能曲线连续性的电生理分析

分析房室结折返性心动过速 (AVNRT)中房室结功能曲线呈连续性者的电生理特点。将AVNRT分为房室结功能曲线连续组 (Ⅰ组 )及房室结功能曲线不连续组 (Ⅱ组 ) ,行慢径消融 ,进行消融前后和组间的电生理比较 ,分析房室结功能曲线呈连续性者的特点。结果 :I组心房程序刺激对AVNRT的诱发率仅 42 % (5 / 12 ) ,低于Ⅱ组的 6 6 %(2 3/ 35 )。Ⅰ组房室结前传有效不应期 (ERP AVN)消融前后无显著变化 (2 18.2± 2 9.3msvs 2 5 3.3± 80 .3ms,P >0 .0 5 ) ;心房程序刺激最长A2 H2 间期 (AHmax)消融前后无显著变化 (2 2 5 .8± 71.8msvs 175 .4± 41.9ms,P >0 .0 5 )。Ⅱ组ERP AVN消融后显著延长 (2 78.9± 5 8.9msvs 2 35 .8± 39.6ms,P <0 .0 5 ) ;AHmax消融后显著缩短 (172 .0± 6 7.1msvs 331.6± 86 .6ms ,P <0 .0 5 ) ;消融后房室结快径前传有效不应期 (ERP FP)显著缩短 (2 78.9± 5 8.9msvs 330 .0±5 5 .3ms,P <0 .0 5 )。消融前Ⅰ组AHmax短于Ⅱ组 (P <0 .0 5 ) ,Ⅰ组心动过速时A2 H2 间期 (AHSVT)与消融前AHmax比较差异无显著性 (P >0 .0 5 ) ;Ⅱ组AHSVT短于消融前AHmax(P <0 .0 5 )。结论 :房室结功能曲线连续性者较难经常规心房程序刺激诱发心动过速 ;慢径消融后曲线“尾巴”消失可作为消融终点的一项指

Electrophysiological Analysis of Continuous Atrioventricular Nodal Function Curve of Atrioventricular Nodal Reentrant Tachycardia.

To analyse the electrophysiological characteristics of continuous atrioventricular nodal function curve of atrioventricular nodal reentrant tachycardias(AVNRT),the patients performed slow pathway ablation were devided into two groups.Group Ⅰ included twelve patients with AVNRT and continuous atrioventricular nodal function curves,group Ⅱ included thirty five patients with AVNRT and discontinuous AV nodal function curves.Results: The rate of AVNRT induced by atrial programmed stimulation in group Ⅰ was only 42%(5/12),lower than that in group Ⅱ,which was 66% (23/35).In group Ⅰ,the effective refractory period of the AV node (ERP AVN) was 218.2±29.3 ms before ablation,253.3±80.3 ms after ablation ( P >0.05);the maxmium A 2H 2 interval (AHmax) was 225.8±71.8 ms before ablation,175.4±41.9 ms after ablation ( P >0.05).In group Ⅱ,ERP AVN was 235.8±39.6 ms before ablation,278.9±58.9 ms after ablation ( P <0.05);AHmax was 331.6±86.6 ms before ablation,172.0±67.1 ms after ablation ( P <0.05);the effective refractory period of the fast pathway(ERP FP) was 330.0±55.3 ms before ablation,278.9±58.9 ms after ablation ( P <0.05).The AHmax of group Ⅱ was prolonged than that of group Ⅰ( P <0.05).Before ablation,in group Ⅰ,there was no significant difference between A 2H 2 interval during AVNRT(AH SVT ) and AHmax ( P >0.05);in group Ⅱ,AH SVT was shorter than AHmax ( P <0.05).Conclusion:The tachycardia accompanied with continuous atrioventricular nodal function curve was relatively hard to be induced by atrial programmed stimulation.The "missing tail" of the curve can be determined as the end point of slow pathway ablation.The main cause of continuous atrioventricular nodal function curve may be the similarity of the refractory periods of fast pathway and slow pathway and relatively little difference of the conduction time between them.Chinese Journal of Cardiac Pacing and Electrophysiology,2000,14(3):164～166]