慢慢型房室结折返性心动过速的电生理机制和射频导管消融治疗  

Electrophysiologic mechanism and radiofrequency ablation of slow/slow atrioventricular nodal reentrant tachycardia

作　　者：王祖禄[1] Jackman WM 韩雅玲[1] 梁延春[1] 梁明[1] 徐凯[1] 

机构地区：[1]沈阳军区总医院心内科,110016 [2]美国Oklahoma大学电生理中心

出　　处：《中华心律失常学杂志》2005年第1期17-24,共8页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的探讨慢慢型房室结折返性心动过速(AVNRT)的电生理机制和不同射频导管消融方法的治疗效果.方法 812例AVNRT患者分为两组,第1组500例,比较慢慢型中前传慢径和逆传慢径的成功消融部位的异同、比较在慢慢型和快慢型中选择性地消融逆传慢径部位的异同.第2组312例,在设想慢慢型AVNRT折返机制的基础上,前瞻性地对慢慢型仅选择性消融前传慢径而不消融逆传慢径.结果第1组59例慢慢型AVNRT的前传和逆传慢径的传导时间和成功消融的部位明显不同,逆传慢径多在冠状静脉窦(CS)窦口内或CS近端消融成功,而前传慢径多在三尖瓣环和CS窦口之间消融成功;慢慢型与快慢型的逆传慢径有明显不同的传导时间、递减特性和解剖分布.在第2组前瞻性地仅消融前传慢径治疗22例慢慢型组中,在三尖瓣环和CS窦口之间成功消融前传慢径并治愈AVNRT后,21例逆传慢径功能不变,其逆传慢径最早心房插入点部位与前传慢径消融部位不同.所有812例AVNRT均消融成功,第1组在3年以上的随访中,387例慢快型复发1例(0.3%),59例慢慢型复发6例(10%),54例快慢型无复发.第2组312例3～48(23±12)个月的随访中,慢快型复发2例(0.5%),慢慢型和快慢型无复发.结论 (1)慢慢型AVNRT应用电生理特性和解剖分布不同的两条慢径形成折返环的前传支和逆传支,其前传和逆传慢径的解剖基础可能分别为房室结的右侧后延伸和左侧后延伸;(2)在大多数慢慢型AVNRT中,仅消融前传慢径有很高的成功率和低复发率.Objective To investigate the electrophysiologic mechanism and the effect of radiofrequency catheter ablation in slow/slow form of atrioventricular nodal reentrant tachycardia(AVNRT).Methods Eight hundred and twelve patients with AVNRT referred for ablation were divided into 2 groups.Group 1 consisted of 500 patients.The electrophysiologic properties and the sites with successful ablation between the retrograde slow pathway(retro-SP)and the antegrade SP(ante-SP)in slow/slow AVNRT were compared,and the successful ablation sites of (retro-SP) between slow/slow and fast/slow AVNRT were also compared.In group 1 patients with slow/slow AVNRT,the (retro-SP) was initially ablated. Group 2 consisted of 312 patients.Based on the hypothesis of the reentrant circuit for slow/slow AVNRT,the ante-SP was prospectively ablated by electroanatomic guided approach despite the existence of the (retro-SP) in slow/slow AVNRT,and the successful ablation site for ante-SP and the earliest atrial insertion site of (retro-SP) were compared.Results In group 1,59 patients had slow/slow AVNRT and 54 patients had fast/slow AVNRT.In slow/slow AVNRT,the (ante-SP) and (retro-SP) conduction time during tachycardia and the successful ablation sites between ante-SP and (retro-SP) were significantly different.The (retro-SP) was mostly ablated at the CS ostium or within the proximal CS and the ante-SP was mostly ablated between the tricuspid annulus and CS.The conduction time,the decremental properties and the successful ablation sites of the retro-SP between slow/slow and fast/slow AVNRT were all significantly different.In group 2,slow/slow AVNRTwas successfully eliminated in all 22 patients targeting the ante-SP by electroanatomic guided approach.After ablation of ante-SP,the retro-SP conduction had no change in 21 slow/slow AVNRT patients.During follow-up,6 of the 59 patients with slow/slow AVNRT in ( )group 1 had recurrence,and no recurrence in the 22 patients with slow/slow AVNRT in group 2.Conclusions (①In slow/slow) AVNRT,the an

关 键 词：慢慢型房室结折返性心动过速 电生理机制 射频导管消融治疗 心房激动 异丙肾上腺素 

分 类 号：R541.7[医药卫生—心血管疾病]