显性旁道与发作性心动过速的相关研究——食管心房调搏术与心内电生理检查对照再评价  

Correlation Between Manifest Atrioventricular Bypath and Paroxysmal Tachycardia ——Reevaluating the Comparison of Trans-Esophageal Programming Atrial Pacing and Intra Cardiac Physiological Study

作　　者：徐金义[1] 吴蕊[1] 邱妍妍[1] 

机构地区：[1]河南省人民医院心功能科,河南省郑州市450003

出　　处：《中国循环杂志》2013年第5期334-337,共4页Chinese Circulation Journal

基　　金：河南省科技厅科研基金资助课题(112102310665)

摘　　要：目的:通过食管心房调搏术与心内电生理检查对照再评价,探讨显性旁道与发作性心动过速的相关性。方法:选择既往有心动过速发作史且体表心电图显示心室预激的40例患者,依其心电图特点分为左侧旁道组19例,右侧旁道组21例,均行食管心房调搏术与心内电生理检查,将结果进行统计分析。结果:40例患者用食管心房调搏术法诱发心动过速31例(77.5%),心内电生理检查法诱发心动过速35例(87.5%),差异无统计学意义(P>0.05)。左侧旁道组食管心房调搏术15例诱发心动过速,其中12例显性左旁道参与顺向型房室折返性心动过速(OAVRT),1例隐匿性右旁道参与OAVRT,2例房室结双径路伴慢快型房室结折返性心动过速(SFAVNRT);心内电生理法16例诱发心动过速,其中13例显性左旁道参与的OAVRT,2例房室结双径路伴SFAVNRT,1例隐匿性右旁道参与的OAVRT。右侧旁道组食管心房调搏术16例诱发心动过速,其中10例显性右旁道参与OAVRT,5例隐匿性左旁道参与OAVRT,1例右心房内折返性心动过速(RIART);心内电生理法19例诱发心动过速,其中13例显性右旁道参与OAVRT,5例隐匿性左旁道参与OAVRT,1例RIART。两组两种不同检查方法诊断结果比较,差异均无统计学意义(P>0.05)。心电图显性旁道参与折返形成的OAVRT诱发率(经食管心房调搏术55%;心内电生理65%)较其它机制心动过速的诱发率(经食管心房调搏术22.5%;心内电生理22.5%)高(P<0.05)。结论:显性旁道与心动过速的发作有一定的相关性,但并非所有患者的显性旁道与其发作性心动过速必然相关。当患者存在显性房室旁道且伴有心动过速发作史时,建议先经食管心房调搏术,若诱发心动过速的机制不能用显性旁道来解释,即出现"矛盾"现象时,说明该患者同时存在其他机制的心动过速。Objective： To explore the correlation between manifest atrioventricular bypath （MAVB） and paroxysmal tachycardia by reevaluating the comparison between trans-esophageal programming atrial pacing and intra cardiac electrophysiological study. Methods： We performed trans-esophageal programming atrial pacing （TEAP） and intra cardiac electrophysiological study （EPS） in 40 patients of paroxysmal tachycardia with the history of ventricular pre-excitation in ECG. According to ECG features, the patients were divided into 2 groups, Left bypath group, n=19 and Right bypath group, n=21. The outcomes and differences between TEAP and EPS in both groups were statistically analyzed. Results： There 31/40 patients had TEPA induced tachycardia （induction rate 77.5%） and 35/40 had EPS induced tachycardia （induction rate 87.5%）, P〉0.05. ① In Left bypath group, 15/19 patients had induced tachycardia by TEAP, among them, 12 patients with atrioventricular reentrant tachycardia （OAVRT） via left pathway, 1 with OAVRT via right pathwayand 2 with S-F atrio-ventricular nodal reentrant tachycardia （S-F AVNRT） via double atrioventricular node pathways. By intra cardiac EPS, 16 patients had induced tachyeardia, 13 OAVRT via left pathway, 2 S-F AVNRT and 10AVRT via right pathway. ②In Right bypath group, there 16/19 had induced tachycardia by TEAP, among them, 10 patients with OAVRT via right bypath, 50AVRT via left pathway and 1 right intra atrial reentrant tachyeardia （R-IART）. By intra cardiac EPS, 19 patients had induced tachyeardia, and 13 OAVRT via right pathway, 50AVRT via left pathway and 1 R-IART. The diagnostic differences in both methods between 2 groups were similar, P〉0.05. The MAVB induced OAVRT （TEPA 55% and EPS 65%） were higher than other induction （TEPA 22.5% and EPS 22.5%）, P〉0.05. Conclusion： MAVB is related to paroxysmal tachycardia at certain point. For patients suffering from MAVB with the history of tachycardia, TEAP is the first recommended treatment. If MAVB can

关 键 词：显性旁道 心室预激 心动过速 食管心房调搏 心内电生理 

分 类 号：R54[医药卫生—心血管疾病]