右心室拖带时局部室房间期用于鉴别室上性心动过速  

Identification of supraventricular tachycardia by using the shortest local ventricle-atrium interval

作　　者：雷森[1] 何泉[1] 贾锋鹏[1] 高凌云[1] 罗素新[1] Lei Sen;He Quan;Jia Fengpeng;Gao Lingyun;Luo Suxin(Department of Cardiovascular Medicine,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院心内科,400016

出　　处：《中华心律失常学杂志》2020年第4期406-409,共4页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的探索右心室拖带时与心动过速时冠状静脉窦(CS)导管最短室房(VA)间期是否可用于鉴别房室结折返性心动过速(AVNRT)与间隔或右侧旁路参与的顺向型房室折返性心动过速(AVRT)。方法纳入2015年12月至2017年12月在重庆医科大学附属第一医院心内科行射频导管消融的室上性心动过速(SVT)患者,排除了心动过速时CS导管明确离心性传导者、1种机制以上的SVT以及不能拖带者,最终纳入患者120例。通过常规电生理检查明确患者诊断并行射频导管消融,消融前行右心室起搏拖带。比较拖带与心动过速时10极CS导管最短VA间期。其通道应选择VA间期最短及局部心房波最早者。结果AVNRT患者CS导管最短VA间期差值显著大于AVRT患者[(85.5±28.8)ms对(-4.3±15.7)ms,P<0.0001]。任一个AVNRT患者(慢快型、快慢型或慢慢型),差值均>40 ms;任一个AVRT患者(无论是间隔旁路还是右侧旁路),其差值均<30 ms。结论比较右心室拖带时与心动过速时CS导管最短VA间期可有效鉴别AVNRT或AVRT。Objective Atrioventricular nodal reentrant tachycardia(AVNRT)and atrioventricular reentrant tachycardia(AVRT)using septal or right side accessory pathway(AP)during electrophysiological study is sometimes hard to identify.This study was aimed to investigate a new method to differentiate patients with AVNRT and patients with AVRT.Methods One hundred and twenty patients with supraventricular tachycardia in Department of Cardiovascular Medicine of the First Affiliated Hospital of Chongqing Medical University from December 2015 to December 2017 were included in the study.Diagnoses of AVNRT or AVRT through a septal or right side concealed AP were made according to conventional electrophysiological criteria and ablation results.Entrainment by right ventricular(RV)pacing was performed in each patient before ablation,and patients with successful entrainment were included in the study.The shortest local ventricle-atrium interval in coronary sinus was compared during pacing and during tachycardia between patients with AVNRT and patients with AVRT.Results The shortest local ventricle-atrium interval difference in patients with AVNRT was significantly longer than that in patients with AVRT using septal or right side AP[(85.5±28.8)ms vs.(-4.3±15.7)ms,P<0.0001].In all patients with AVNRT,the difference was more than 40 ms.While in all patients with AVRT using septal AP and right free wall AP,the difference was less than 30 ms.Conclusion The shortest local ventricle-atrium interval difference in CS was found to be a rapid,useful maneuver in distinguishing patients with AVNRT from those with AVRT using septal AP and right free wall AP.

关 键 词：心动过速 室上性 机制 心室拖带 

分 类 号：R541.71[医药卫生—心血管疾病]