射频消融慢径对房室结双径路患者房室结传导功能的影响  

The influence of radiofrequency ablation of the slow pathways on the conduction of atrioventricular node inpatients with dual atrioventricular nodal pathways

作　　者：周菁[1] 任自文[1] 丁燕生[1] 吴林[1] 陈健[1] 柳景华[1] 罗维[1] 

机构地区：[1]北京医科大学第一医院电生理组,100034

出　　处：《中华心血管病杂志》1999年第1期45-47,共3页Chinese Journal of Cardiology

摘　　要：目的初步探讨房室结双径路之间的电生理联系。方法对３９例（男１３例，女２６例）平均年龄（４６．６±１６．４）岁的房室结折返性心动过速患者进行房室结慢径消融，观察慢径消融对房室结传导功能的影响。结果成功率１００％，２６例消融后慢径消失（Ⅰ组），１３例消融后慢径残存（Ⅱ组）。消融前后Ⅰ组房室结快径前传有效不应期由（３３２．５±４９．５）ｍｓ缩短为（２８２．５±５８．０）ｍｓ，前传功能不应期由（３８２．９±５５．３）ｍｓ缩短为（３４６．３±３８．０）ｍｓ，前传文氏周期由（３５０．０±５５．４）ｍｓ缩短为（３２６．２±５１．６）ｍｓ，差异均有显著性；Ⅱ组房室结快径前传有效不应期由（３２７．７±７９．０）ｍｓ缩短为（２９０．８±７９．５）ｍｓ，差异有显著性，而房室结慢径前传有效不应期、前传功能不应期和文氏周期差异均无显著性。Ⅰ组射频前后快径上相同Ａ１Ａ２间期Ａ２Ｈ２快径最大值与对应Ａ２Ｈ２相比，由（１６４．４±４５．９）ｍｓ缩短为（１２９．１±５７．５）ｍｓ，射频前后快径上相同Ａ１Ａ２间期快径前传有效不应期前４０ｍｓ的对应Ａ２Ｈ２相比，由（１４２．３±４９．６）ｍｓ缩短为（１２２．３±５４．６）ｍｓ，差异均有显著性。Ⅱ?Objective To assess the relationship between two atrioventricular nodal pathwary. Methods Total 39 consecutive patients with atrioventricular nodal reentrant tachycardia, 26 females and 13 males, aged(46.6±16.4) yare old, were studied. Results The slow pathways were ablated in all the patients. The totalsuccessful rate was 100%. After ablation, slow pathways completely disappeared in 26 patients (Group I); slow remained in 13 patients (Group Ⅱ). Compe with pre-ablation in Grope Ⅰ, ERP-FP decreased from(332.5±49.5) ms to (282.5±58.0) ms, FRP-AVN decreased from (382.9±55.3) ms to (346.3±38.0)ms, Wen-AVN decreased from (350.0±55.4) ms to (326.2±51.6) ms (all P<0.05). In Group Ⅱ, ERPFP decreased from (327.7±79.0) ms to (290.8±79.5) ms (P<0.05), ERP-SP, FRP-AVN and Wen-AVNhad no obvious change. Two corresponding points in fast pathway (AH-FPmax corresponding and AH-FP 40 mscorresponding) were compared before and after ablation. In Group Ⅰ, AH-FPmax corresponding decreased from(164.4±45.9) ms to (129.1±57.5) ms, AH-FP4O ms corresponding decreased from (142.3±49.6) ms to(122.3±54.6) ms (both P<0.05). In Group Ⅱ, AH-FPmax corresponding decreased from (190.8±63.9)ms to (150.0±75. 3) ms (P<0.05), but there was no obvious change in AH-FP40ms corresponding comparedbefore to after ablation. FRP-AVN or Wen-AVN was correlated with both ERP-FP and ERP-SP before and afterablation in either group, unless ERP-SP did not exist after ablation in Group Ⅰ (except that no statisticallysignificant change was reached in the correlation between Wen-AVN and ERP-FP before ablation). ConclusionTwo AV nodal pathways had functional interaction. Selective ablation of slow pathway might improve the conductionof antegrate fast pathway.

关 键 词：心动过速 房室结折返性 导管消融术 电生理学 

分 类 号：R541.710.5[医药卫生—心血管疾病]