快慢型房室结折返性心动过速的电生理特点  

Electrophysiological characteristics of fast-slow atrioventricular nodal reentrant tachycardia

作　　者：李洁[1] 高树军 齐书英[1] 李育红[1] 苏进肖 王琼[1] 许守涛 

机构地区：[1]白求恩国际和平医院心内科,0500821 [2]空军石家庄西三庄干休所,050000

出　　处：《临床心电学杂志》2013年第5期347-349,共3页Journal of Clinical Electrocardiology

摘　　要：目的分析快慢型房室结折返性心动过速(AVNRT)患者的临床特征、心电图和电生理检查特点、射频消融治疗特点,旨在为临床长RP'心动过速鉴别提供帮助。方法 11例经心内电生理检查证实为慢快型房室结折返性心动过速的患者,回顾性分析其临床特征、心电图特点及电生理检查特点及射频消融治疗。结果心动过速表现为窄QRS波心动过速,RP'>P'R,P'在Ⅱ、Ⅲ、aVF导联倒置,RP'间期为350±25ms,心率为166±30bpm。11例患者中有3例出现室房逆传跳跃现象。心房程序刺激无明显跳跃现象,11例均可由心房S1S2刺激诱发心动过速发作,且容易诱发,容易终止。心动过速发作时,5例CS9.10 A波最早,6例HiS的A波最早,其中1例静推ATP心动过速终止。11例患者中9例经房室结改良消融传统慢径获得成功,2例在冠状静脉窦内消融成功,术后随访3个月以上均未再发作心动过速。结论长RP'心动过速的诊断和鉴别诊断有一定困难,如能排除慢旁道和房速,应考虑快慢型房室结折返性心动过速。Objective To explore ECGs and tachycardia characteristics （electrophysiological characteristics） of the fast-slow atrioventricular nodal reentrant tachycardia （AVNRT）. Methods II cases of patients with long RP＇ interval who diagnosed as fast-slow AVNRT by electrophysiological examinatrion and cured by radiofreqency ablation. Results ECG characteristics： narrow QRS complex, RP＇〉 P＇R, P wave was inverted in U, m, aVF lead, the RP＇ interval was 350 ± 25ms, the heart rate was 166± 30beats/min. Characteristics of cardiac electrophysiology examination： ventrictdar stimulation confirmed that neither the bypass nor atrial tachycardia exist, there were jumping of ventricular-atrial conduction in 3 cases. Atrial programmed stimulation confirmed no jumping phenomenon. The tachycardia can be evoked by StS2 atrial stimulation in all cases, and spontaneous premature atrial beat repeatedly induced tachycardia in l case. The earliest retrograde A wave was at CS9.10 in 5 cases and at His in 6 cases, with AH interval shorter than HA interval Tachycardia was easily. The tachycardia was terminated by bolus ATP injection in 1 case. 9 cases were cured successfully by traditional slow pathway ablation and 2 cases by ablation in CS. There were no complications and recurrence in 6 months＇ follow-np. Conclusions It is difficult undertaking differential diagnosis of long R-P＇ tachycardia. If slow pathway and atrial tachycardia were excluded, the fast-slow AVNRT should be taken into account. In most fast-slow AVNRT patients, the successful ablation sites are the traditional slow pathway.

关 键 词：房室结折返性心动过速 心电图 电生理检查 

分 类 号：R541.7[医药卫生—心血管疾病] R540.41[医药卫生—内科学]