His束逆传不应期心室早搏刺激鉴别间隔隐匿性旁道与房室结折返性心动过速  

Distinguishing of Concealed Septal Accessory Pathway and Atrioventricular Node Reentrant Tachycardia Using the Ventricular Extra-Stimulus During Tachycardia His Bundle Refractory

作　　者：许力舒[1] 姜述斌[1] 杨敏全[1] 帕尔哈提[1] 吴忠东[1] 

机构地区：[1]新疆维吾尔自治区人民医院心内科,新疆乌鲁木齐830001

出　　处：《中国心脏起搏与心电生理杂志》2004年第3期169-171,共3页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：探讨His束逆传不应期心室早搏刺激法临床应用时的注意事项。 37例慢 快型房室结折返性心动过速(AVNRT)和 2 0例间隔部隐匿性快旁道引起的房室折返性心动过速 (AVRT)患者 ,成功消融前在常规行腔内电生理检查的同时均行His束逆传不应期心室早搏刺激法。结果 :心动过速时His束逆传不应期内心室早搏刺激 ,37例AVNRT患者心房激动无明显提前 ,2 0例AVRT心房被提前激动超过 2 0 (30～ 5 0 )ms ,其中 9例终止心动过速 ,此方法鉴别AVRT和AVNRT特异度、灵敏度较高。结论 :心动过速时His束逆传不应期行心室早搏刺激法鉴别诊断AVRT和AVNRT操作简单、准确性高。但行此法检查时要求有持续发作的心动过速 ;能够标测出清晰的His束电位 ;心室早搏刺激最好与His束电位同步发放 ;To distinguish concealed septal accessory pathway and atrioventricular node reentrant tachcardia(AVRT,AVNRT),the ventricular extrastimulus was used in 37 patients with slow fast AVNRT and 20 patients with concealed septal accessory pathway during tachycardia His bundle refractory.Results: A late ventricular extra stimulus during tachycardia could advance the time of atrial activation over 20 ms at the time when His bundle was refractory in 20 AVRT with concealed septal accessory pathway, terminated the tachycardia in 9 patients; but could not advance the time of atrial activation in 37 patients with AVNRT. The way distinguished and diagnosed AVRT using concealed septal fast pathway from slow fast AVNRT, the sensitivity and specificity were 100%.Conclusion: Ventricular extra stimulus given during tachycardia His bundle refractory is simple and could be used wide spread in clinical, with high sensitivity and specificity . It is difficult to be used effectively if tachycardia could not be induced, not sustained, rhythm irregular,and His bundle mapping not clear. It had better that ventricular extra stimulus is at the same time with His bundle mapping. Do repeat the way several times would be helpful in diagnosis.

关 键 词：电生理学 心室早搏刺激 His束逆传不应期 鉴别诊断 

分 类 号：R331.38[医药卫生—人体生理学] R541.71[医药卫生—基础医学]