右中间隔心底部和心尖部刺激鉴别间隔部隐匿性房室旁道的作用  

To evaluate the value of right ventricular stimuli in right midseptal and apex in distinguishing septal fast pathway

作　　者：姜述斌[1] 吴忠东[1] 帕尔哈提[1] 许力舒[1] 赵勤英 

机构地区：[1]新疆医科大学附属中医医院心脏中心,乌鲁木齐830000 [2]新疆民政康复中心

出　　处：《中国介入心脏病学杂志》2013年第4期216-219,共4页Chinese Journal of Interventional Cardiology

摘　　要：目的评价右中间隔心底部和心尖部刺激对间隔隐匿性房室折返性心动过速(AVRT)的诊断价值。方法通过希氏束逆传不应期行心室早搏刺激法将142例患者分为74例慢-快型房室结折返性心动过速(AVNRT)和68例间隔隐匿性快旁道引起的AVRT患者,成功消融前均常规行腔内电生理检查,并在此基础上加用同频率右中间隔心底部和心尖部刺激:窦性心律时以120次/min的相同频率,分别刺激心尖和心底部,比较各自右心室的V波至逆传心房产生逆传A波的时限(VA)。结果希氏束逆传不应期行心室早搏刺激检测结果:心动过速时,希氏束逆传不应期内心室早搏刺激,74例快-慢型AVNRT患者心房激动不能提前(变化小于10ms),68例AVRT患者心房均被提前激动超过20ms(30～50ms)。同频率心尖部和右中间隔心底部刺激法检测结果:心尖部刺激所测的VA减去自身心底刺激所测的VA差值AVNRT患者为-65～6(-41±17)ms;间隔旁道引起的AVRT患者22～63(34±10)ms,两者间差异有统计学意义(P<0.01)。各例间隔旁道引起的AVRT患者的差值均大于10ms,各例AVNRT患者均小于10ms,两者间无重叠现象出现。5例AVNRT患者和3例间隔旁道引起的AVRT患者检测失败。结论窦性心律时同频率心尖部、右中间隔心底部起搏刺激法鉴别诊断AVRT和AVNRT的敏感性和特异性很高,而且操作简单,便于在临床上推广应用。Objective To evaluate the value of septal pathway stimulation in diagnosis orthodromic atrioventricular reciprocating tachycardia （OAVRT）. Methods All 142 patients were categorized into slow- fast AVNRT （n = 70） and AVRT （n = 68） by means of concealed septal accessory pathway by ventficular extra-stimuli during taehycardia and His bundle refractory. All patients underwent invasive electrophysiologieal studies before radiofrequeney ablation （RFCA） , including the right ventrieular stimuli in right midseptal and apex. Right ventricular stimuli were introduced in right midseptal and apex with the same frequency （120 bpm） in every patient during sinus rhythm, measured VA interval respectively, Results By applying ventricular extra-stimuli during taehycardia and His bundle refractory, a late ventricular extra- stimulus during tachyeardia could advance the time of atrial activation over 20 ms at the time when His bundle is refractory in 68 AVRT with concealed septal accessory pathway, but could not advance the time of atrial activation （ less than 10 ms） in 74 AVNRT. The way can distinguish and diagnose AVRT using concealed septal fast pathway from slow-fast AVNRT which sensitivity and specificity was 100%. When fight ventricular stimuli were given in right apex and midseptal with the same frequency during sinus rhythm, the VAapex-VABase was - 41± 17 （ - 65 - 6） ms in AVNRT and 34±10 （ 22 - 63 ） ms in AVRT （ P 〈 0. 01 ）. Each difference was above lOres in AVRT, below 10 ms in AVNRT and no overlap was found. The method was performed unsuccessfully in 5/74 AVNRT patients and 3/68 AVRT patients with septal concealed pathway. Conclusions Right ventricular stimuli were given in right apex and midseptal with the same frequency during sinus rhythm. The method could be used clinically with high sensitivity and specificity.

关 键 词：右中间隔心底部和心尖部刺激 间隔部快旁道 鉴别诊断 

分 类 号：R541.7[医药卫生—心血管疾病]