频率依赖性隐匿性房室旁道伴发的心动过速及射频消融  

The characteristics and radiofrequency catheter ablation of supraventricular tachycardia affiliated with rate-dependent concealed atrioventricular pathway

作　　者：刘书旺[1] 李红梅[1] 李晓梅[1] 李洪稳[1] 尚爱英[1] 周继新[1] 靳荣芬[1] 

机构地区：[1]河北省沧州市中心医院心内科,061001

出　　处：《中国介入心脏病学杂志》2004年第1期31-34,共4页Chinese Journal of Interventional Cardiology

摘　　要：目的　研究频率依赖性隐匿性房室旁道伴发的心动过速特点及射频消融治疗。方法　6例患者 ,男性 2例 ,女性 4例 ,年龄 14～ 6 8岁。电生理检查包括采用右室心尖部和左室S1S1及S1S2起搏分析室房传导情况、心动过速特点、旁道位置确定及射频消融治疗。结果　左侧游离壁 5例 ,右侧三尖瓣环 11点处 1例。具有旁道 1∶1室房传导功能 5例 ,传导窗口 80～ 10 0ms,有偶发旁道逆传现象 4例 ,诱发心动过速 5例。在右室起搏下标测靶点 ,所有病例均消融成功。结论　隐匿性房室旁道发生 3位相或 4位相阻滞时表现为频率依赖性室房传导。电生理检查过程中应注意分辨偶发室房逆传现象 ,以免漏诊。Objective To investigate characteristics of supraventricular tachycardia affiliated with rate-dependent concealed accessory pathway and the results of radiofrequency catheter ablation (RFCA). Methods Six patients (including 4 females and 2 males, agd from 14 to 68 years) had received electrophysiologic studies and RFCA, which included observing the properties of ventriculoatrial conduction while incremental pacing (S 1S 1) and single extrastimuli (S 1S 2) were performed in right ventricular apex (RVA) and left ventricle (LV), investigating the characteristics of tachycardia, mapping accessory pathway and evaluating the results from RFCA. Results There were 5 left free wall concealed accessory pathways and 1 right concealed accessory pathway at 11 o′clock of tricuspid valve in 6 patients. Five cases were confirmed with 1∶1 ventriculoatrial conduction through the concealed accessory pathway from RVA or LV pacing. The duration of the window ranged from 80 to 100 ms. Four cases were confirmed with accidental retrogradation through the concealed accessory pathway. The supraventricular tachycardia could be induced in 5 cases. All patients were successfully ablated from RVA pacing. Conclusion These results suggest that ventriculoatrial conduction would be rate-dependent because concealed accessory pathway takes place at phase block 3 or 4. In electrophysiologic studies we shoud carefully identify the accidental retrogradation through the concealed accessory pathway to avoid missed diagnosis.

关 键 词：频率依赖性隐匿性房室旁道 心动过速 射频消融 电生理检查 合并症 

分 类 号：R541.71[医药卫生—心血管疾病] R540.41[医药卫生—内科学]