逆向型房室结双径路的电生理特征  

On Electrophysiologic Characteristics of Retrograde Dual Atrioventricular Nodal Pathways

作　　者：叶行舟[1] 黄玉[1] 马长生[2] 杨新春[2] 商丽华[2] 董建增[2] 胡大一[2] 

机构地区：[1]南京铁道医学院附属医院 [2]北京红十字朝阳医院

出　　处：《南京铁道医学院学报》1996年第4期264-267,共4页Journal of Nanjing Railway Medical College

摘　　要：目的：研究逆向型房室结双径路的电生理特征。方法：对１５０例房室结双径路伴房室结折返性心动过速患者行常规高右房递增起搏（Ｓ１Ｓ１）及程序刺激（Ｓ１Ｓ２）和右心室心尖部递增起搏及程序刺激。结果：１８例（１２％）出现逆向型房室结双径路，右室Ｓ１Ｓ１起搏时发生经慢径逆传的Ｓ１Ｓ１周长为（４３０±５７）ｍｓ，快、慢径逆传的Ｖ－Ａ值差为（１５０±５６）ｍｓ，右室Ｓ１Ｓ２刺激发生快、慢径跳跃时Ｓ１Ｓ２间期为（３３０±５８）ｍｓ，Ｖ－Ａ值延长（１７０±６５）ｍｓ。当心室激动经快径逆传时ＨＢＥ上的Ａ波较ＣＳｐ上Ａ波早（２０±９）ｍｓ，经慢径逆传时ＣＳｐ上Ａ波较ＨＢＥ上Ａ波早（１０±９）ｍｓ。其中１６例激动经慢径逆传时仅能逆传１～２个心室激动就发生阻滞，仅２例在右室Ｓ１Ｓ１刺激时可持续经慢径逆传。所有１８例均可见逆向型房室结折返性心室回波。１８例中，１４例发生慢－快型房室结折返性心动过速，２例发生慢－慢型房室结折返性心动过速，仅２例为典型的快－慢型房室结折返性心动过速。结论：房室结双径路患者的房室结内慢径虽有逆传功能，但绝大多数病例慢径的逆传功能脆弱。bjective :The purpose of this paper is to study the electrophysiologic characteristics of the retrograde dual atrioventricular(AV)nodal pathways.Method :One hundred and fifty patients with supraventricular tachycardia related to dual AV nodal pathways were studied cardioelectrophysiologically,including(1)incremental pacing(S 1S 1) at high right atrium(HRA) and right ventricular apex(RVA);(2)programmed stimulation or extrastimulus(S 1S 2) at HRA and RVA.Result :(1)The slow pathways of the AV nodes with retrograde conduction function were found in 18 cases;(2)When S 1S 1 pacing cycle periods at RVA were dcecreased to (430±57)ms,retrograde Wenckebach periodicity with unexpected sudden increase of VA interval to (150±56)ms was noted;(3)Ventricular S 1S 2 studies at coupling periods of (330±58)ms revealed discontinuous V 1V 2、A 1A 2 curves due to sudden increase of V 2A 2 interval,which were about (170±65)ms,suggesting retrograde dual AV nodal pathways;(4)AV nodal reentrant ventricular echoes occured when ventricular stimulations were conducted via the slow pathways in all 18 patients;(5)The fastslow form(retrograde) AV nodal reentrant tachycardia(AVNRT) was induced in 2 of 18 cases, although retrograde dual AV nodal pathways were found in all the 18 cases.The slowfast form(antergrade) AVNRT was induced in 14 cases and the remaind two had a slowslow form AVNRT.Conclousion :We consider that the retrograde conduction function of the slow pathway of dual AV nodal pathways is very weak,and that it cound be induced in fewer patients with retrograde dual AV nodal pathways.

关 键 词：房室结双径路 心室回波 电生理 

分 类 号：R540.4[医药卫生—心血管疾病]