无休止性房室折返性心动过速的电生理机制及射频消融  

Electrophysiologic mechanism and radiofrequency catheter ablation of incessant atrioventricular reentrant tachycardia

作　　者：单其俊[1] 曹克将[1] 廖铭扬[1] 邹建刚[1] 李闻奇[1] 黄元铸[1] 马文珠[1] 

机构地区：[1]南京医科大学第一附属医院心脏科

出　　处：《中华心血管病杂志》1997年第6期446-449,共4页Chinese Journal of Cardiology

摘　　要：探讨１７例无休止性房室折返性心动过速（ＩＡＶＲＴ），男１２例，女５例，平均年龄４６±１７岁，平均心动过速持续时间３６±７６天，平均心室率１８０±１７次／分，１７例中５例有心功能不全的表现，其中４例发生心动过速所致的扩张性心肌病。后间隔旁路１２例（左１１例，右１例），左和右侧游离壁旁路分别为２例和３例。显示递减性传导特性慢旁路２例。４例ＡＨ间期延长，平均１６１±６毫秒。在后间隔旁路中６例心动过速时体表心电图Ｖ１导联ＲＰ≥ＰＲ，仅有１例具有慢旁路特性。１７例全部消融成功，射频消融后随访１～３８个月均无发作。５例心功能不全者，心动过速终止后１周心功能明显改善；４例心动过速所致的扩张性心肌病平均随访１２个月，３例心脏大小和功能恢复正常，１例心脏渐趋缩小。研究结果表明，Ｉ－ＡＶＲＴ的电生理机制可能与下列因素有关：（１）旁路位置，后间隔发生率最高；（２）旁路性质，心动过速时体表心电图显示旁路逆传时间延长和慢旁路特性易发生；（３）多种因素导致房室结传导时间延长。射频消融对于根治ＩＡＶＲＴ和防治其导致扩张性心肌病具有重要的临床意义。In this report, we presented 17 patients who had incessant atrioventricular reentrant tachycardia (IAVRT). There were twelve men and five women. The average age was 46±17 years old. Mean duration of persistent tachycardia was 36±76 days. Mean ventricular rate was 180±17bpm during tachycardia. Five patients had heart dysfunction and four had tachycardiainduced dilated cardiomyopathy. 17 patients underwent successful radiofrequency catheter ablation. There were eleven accessory pathways (APs) in the leftside posteroseptal position, three in the left free wall, two in the right free wall and one in the rightside posteroseptal position. Two APs had decremental conduction characteristics. Four patients had longer atrioventricular conduction time than normal, mean AH interval was 161±6ms. Six patients had posteroseptal AP with RP≥PR during tachycardia on the surface ECG. All patients were free of symptomatic tachycardia during followup period of 138 months. Five patients who had heart dysfunction improved very much one week after tachycardia ablated. Four tachycardiainduced dilated cardiomyopathies were followed for mean of 12 months, the size and function of the heart were recovered in three patients, the size became smaller in one. It concluded that electriophysiologic mechanism of IAVRT could be related to following factors: (1)position of the AP, posteroseptal AP had the highest incidence of IAVRT; (2) characteristics of AP, AP with RP≥PR during tachycardia on the surfacc ECG and the decremental conduction was easy to lead IAVRT; (3) longer atrioventricular conduction time. As previous described, one or more factor could lead IAVRT. Radiofrequency catheler ablation could eradicate IAVRT and prevent IAVRTinduced dilated cardiomyopathy.

关 键 词：导管消融术 心动过速 室上性 电生理 射频消融 

分 类 号：R541.71[医药卫生—心血管疾病]