房室结双径路合并房室旁路的折返性心动过速及射频消融治疗  被引量:9

Reentrant tachycardia and radiofrequency ablation of dual atrioventricular nodal pathways with atrioventricular accessory pathways

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作  者:盛晓东[1,2] 刘志华[1,2] 宋建平[1,2] 惠杰[1,2] 汪康平[1,2] 蒋文平[1,2] 

机构地区:[1]苏州医学院附属第一医院心内科 [2]江苏省常熟市第二人民医院内科

出  处:《中华心血管病杂志》1998年第1期56-58,共3页Chinese Journal of Cardiology

摘  要:目的本研究旨在探讨房室结双径路(DAVNP)合并房室旁路(AP)的电生理特征和射频消融要求。方法对218例阵发性室上性心动过速(PSVT)进行电生理检查,观察PSVT的前传和逆传途径,然后对AP或房室结慢径(SP)进行消融治疗。结果218例PSVT中检出DAVNP+AP10例,检出率为4.6%。其中SP前传、AP逆传(SP-AP折返)4例,快径(FP)前传、AP逆传(FP-AP折返)1例,SP-AP折返并FP-AP折返或SP/FP交替前传折返4例,SP前传、FP逆传(AP旁观)1例。10例患者均作AP消融,诱发房室结折返性心动过速(AVNRT)的3例加作SP消融,术后随访均无复发。结论DAVNP合并AP者AP均作为逆传途径,阻断AP是消融关键;AP旁观者也应作AP消融;仅有AH跳跃延长者不必接受房室结改良;AP消融者应作DAVNP电生理检查。Objective To examine the electrophysiologic characteristics of dual atrioventricular nodal pathways (DAVNP) with accessory pathways (AP) and evaluate the criteria for radiofrequency catheter ablation. Methods Electrophysiologic study were performed on 218 patients with paroxysmal supraventricular tachycardia (PSVT). The antegrade and retrograde conduction pathways were examined, and the AP or slow pathway (SP) was ablated if necessary. Results Among the 218 patients with PSVT, 10 patients (4.6%) with DAVNP and AP were found. Of the 10 patients, the reentrant pattern with antegrade conduction by SP and retrograde conduction by AP was induced in 4 patients, the pattern with antegrade conduction by fast pathway (FP) in one patient. Four patients manifested antegrade conduction by SP or FP alternatively, and the last one had SP and FP reentry (AP as a bystander).Radiofrequency ablation of AP was performed on all patients and ablation of SP was performed on 3 patients with the initiation of atrioventricular nodal reentrant tachycardia (AVNRT). No recurrence was found during follow up. Conclusion The results suggest that it is crucial to break the conduction of AP in patients with DAVNP and AP. The bystander AP should be ablated also. Patients with AVNRT attacked in the history or initiated during electrophysiologic testing should accept ablation of SP. It seems unnecessary to modifiy the AVN in patients only with the discontinuity of the AH interval. Patients with atrioventricular reentrant tachycardia should undergo electrophysiologic study on DAVNP.

关 键 词:心动过速 室上性 电重量学 射频消融 DAVNP AP 

分 类 号:R541.710.5[医药卫生—心血管疾病]

 

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