逆向型房室折返性心动过速的临床特点  

The Electrophysiologic Characteristic of Antidromic Reciprocating Tachycardia

作　　者：楚建民[1] 马坚[1] 张澍[1] 张奎俊[1] 姚焰[1] 方丕华[1] 王方正[1] 陈新[1] 

机构地区：[1]中国医学科学院中国协和医科大学阜外心血管病医院临床电生理研究室,北京100037

出　　处：《中国心脏起搏与心电生理杂志》2003年第5期350-351,共2页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：探讨逆向型房室折返性心动过速 (ADRT)的临床特点。 397例预激综合征患者进行常规电生理检查和导管射频消融术 ,2 2 (5 .5 % )例 (包括Mahaim纤维旁道 12例 )诱发出ADRT ,心动过速的周长为 30 2± 5 6 (2 30～ 4 10 )ms,2例心动过速时出现低血压伴有头晕 ,4例在心动过速时演化为心房颤动。通过与患者既往临床心电图比较 ,证实 17例有ADRT临床发作 ,常见于多旁道和年轻的患者 (15 / 2 2例 ) ,12例同时伴有顺向型房室折返性心动过速。 19例多旁道患者中 15例逆传经旁道 ,4例逆传经旁道和 /或房室结。 3例单旁道患者在静脉点滴异丙肾上腺素后诱发ADRT ,逆传经房室结。参与构成ADRT的 4 1条旁道 19条位于右侧游离壁 ,9条位于右后间隔 ,3条位于左后间隔 ,7条位于左侧游离壁。 12例前传经Mahaim纤维的ADRT ,其逆传旁道均位于后间隔。 7例普通旁道参与的心动过速其前传支和逆传分别位于右侧、左侧游离壁。 3例单旁道均位于右侧游离壁。结论 :ADRT最常见于多旁道患者并有多种形成机制。During the electrophysiological study of 397 patients referred for evaluation of Wolff-Parkinsion-White syndrome, 22(5.5%) had antidromic reciprocating tachycardia(ADRT). The ADRT cycle length was 230 to 410(302±56) ms. Clinical significant hemodynamic compromise related to ADRT occurred in two patients(2/22,9.9%) and the tachycardia degenerated to atrial fibrillation in four patients(4/22,9.5%) during electrophysiologic study. Orthodromic reciprocating tachycardia was induced simulataneously in 12 patients(12/22,58%). Seventeen patients had clinical ADRT. The clinical ADRT patients were more often younger with multiple accessory pathways. In 12 patients with Mahaim, the postseptal accessory pathways comprised the retrograde limp of the circuit. In the remaining 7 patients with multiple accessory pathways, the spectrum of reentrant circuits included over accessory pathways at different heart side and fusion over both an accessory pathways and the atrioventricular node. Conclusion: The ADRT mechanism included multiple reentrant circuits .

关 键 词：逆向型房室折返性心动过速 临床特点 预激综合征 电生理检查 导管射频消融术 

分 类 号：R541.71[医药卫生—心血管疾病] R540.4[医药卫生—内科学]