房室结折返性心动过速射频消融慢径术后复发的预示  

Predictors of recurrence of atrioventricular nodal reentry after selective slow pathway ablation

作　　者：张清[1] 王海昌[1] 张殿新[1] 刘兵[1] 李媛[1] 李伟[1] 王小燕[1] 

机构地区：[1]第四军医大学西京医院心血管内科,陕西西安710033

出　　处：《第四军医大学学报》2001年第21期1933-1935,共3页Journal of the Fourth Military Medical University

摘　　要：目的　了解房室结折返性心动过速 (AVNRT)射频消融慢径术后与 AVNRT复发有关的因素 .方法　 36 6例典型 AVNRT患者经射频消融慢径后 ,35例 (10 % )复发 .观察射频术后仍有残余慢径传导 ;释放射频能量时无加速性结性心动过速 ;存在房室结“回波”及快径与慢径有效不应期变化四个因素与 AVNRT复发的关系 .结果　 35例复发者中均有残余慢径传导 (10 0 % ) ,331例未复发者中 2 11例 (6 4% )存在残余慢径前向传导 (P<0 .0 1) . 35例复发者中 2 4例 (6 9% )存在房室结“回波”,而在有残余慢径传导未复发的 2 11例患者中有房室结“回波”仅 11例 (5 .2 % ) (P<0 .0 1) ;35例复发者中 6例 (17% )放电时无加速性结性心动过速出现 ,331例未发者中仅 2例 (0 .96 % ,P<0 .0 1) ;复发组房室结快径与慢径有效不应期之差为 (4 7± 2 5 ) ms,未复发组为 (12± 4) ms (P<0 .0 5 ) .结论　射频消融房室结慢径后存在残余慢径传导 ,出现房室结回波 ,释放射频能量时无加速性结性心动过速及残余慢径有效不应期长与复发 AVNRT有关 .AIM To assess the predictors of recurrence of AV nodal reentrant tachycardia (AVNRT) after selective radiofrequency ablation of the slow pathway. METHODSA total of 366 consecutive patients with AVNRT had been successfully treated with selective slow pathway ablation by radiofrequency. The occurrence rates of accelerated junctional tachycardia during radiofrequency application, residual slow pathway conduction and atrioventricular nodal (AVN) echo beats immediately after successful ablation, and the differences between anterograde effective refractory periods (ERP) of fast and slow pathway after successful ablation were compared between 35 patients (10%, group A) with recurrent AVNRT episodes and 311 (90%, group B) without during follow up. RESULTS Six patients (17%) in group A had no accelerated junctional tachycardia during radiofrequency application compared to only 2 (0.96%) in group B ( P <0.01). All patients (100%) in group A had residual slow pathway conduction after successful ablation compared to 211 (64%) in group B ( P <0.01). AVN echo beats after ablation occurred more frequently in group A (24, 69%) than in group B (11, 5.2%) ( P <0.01). The fast slow pathway ERP difference after ablation in group A (47±25) ms was significantly longer than that in group B (12±4) ms ( P <0.05). CONCLUSION Patients with residual slow pathway conduction, and larger fast slow pathway ERP difference, AVN echo beats, after ablation, without accelerated junctional tachycardia during radiofrequency application are at higher risk of recurrent AVNRT.

关 键 词：心动过速 房室结折返性 慢径 消融 复发 

分 类 号：R541.710.5[医药卫生—心血管疾病]