摘要
目的:在房室结双径路部分病例的心内电生理检查中发现存在提前于希氏束(HBE)电位的心房局部慢径电位(Asp),本文旨在探讨Asp出现的部位、电生理特点以及在消融慢径时的临床应用。方法:65例房室结折返性心动过速患者,比较以Asp为靶点消融(A组,n=20)和无Asp时传统方法慢径消融(B组,n=45)的功率、时间、放电次数和复发率。结果:22例(33.85%)描记到慢径电位共131个位点,主要位于M1～P1区(90.84%),较HBE提前(12.63±5.27)ms,AAsp间期(40.27±8.08)ms,AspV间期(61.90±11.55)ms,A组出现结区反应最小时消融功率(4.87±2.53)W,结区反应消失时消融功率(17.80±3.78)W,总消融时间(216.67±46.08)s,平均放电次数为(2.73±1.03)次,两组间有极显著性差异(P<0.01～0.001),所有病例未见房室传导阻滞发生。结论:房室结折返性心动过速患者Asp电生理指标不同于HBE,以Asp为靶点时,消融功率小、放电次数少、放电时间缩短,复发率下降,成功率提高。
Objective:To explore the role of electrophysiologic parameters of the atrial end of slow-pathway potential(A_ sp) and its clinical use of radiofrequency catheter ablation (RFCA) in treating atrioventricular node reentrant tachycardia (AVNRT). Methods:The study consisted of 65 patients with AVNRT.A_ sp were recorded in 22 patients.Electrophysiologic parameters of A_ sp and HBE potentials were assayed before RFCA.There were 20 patients by the guidance of the mapping of A_ sp to sites of slowly-pathway in group A and 45 patients by routine methods in group B.All patients were followed for 6 months to 3 years after ablation. Results:A_ sp whose major sites were located in M_1-P_1 regions occurred 12.63±5.27 msec earlier than HBE potential. A-A_ sp interval was 40.27±8.08 msec and A_ sp-V interval was 61.90±11.55 ms.The minimum power of the first nodal region response was lower in Group A than in group B(4.87±2.53 W vs 16.29±3.75 W, p<0.001) , and the power was similar when the response disappered (17.80±3.78 W vs 23.05±3.52 W, p<0.001). The time of ablation in group A was shorter than in group B(216.67±46.08 s vs 307.03±112.37 s, p<0.001),and the total discharge time in group A was lower than in group B (2.73±1.03 vs 4.43±1.94,p<0.01).AV block was not found. There was no recurrence in group A after ablation but 3 patients had a relapse in group B during 6 months to 3-year follow-up. Conclusions: The electrophysiologic parameters of A_ sp are different from those of HBE potentials in patients with AVNRT. Using of A_ sp in localization of target of slow pathway is more effective than usual technique.
出处
《中国循环杂志》
CSCD
北大核心
2005年第3期203-206,共4页
Chinese Circulation Journal
关键词
心动过速
房室结折返性
导管消融术
心房局部慢径电位
Tachycardia,atrioventricular nodal reentry
Catheter ablation
Atrial end of slow-pathway potential
