摘要
目的 用电 解剖标测方法标测右心房 ,然后比较心房扑动 (AFL)和房室结折返性心动过速(AVNRT)患者在下腔静脉 三尖瓣环峡部 (CTI)和心房间隔部 (AS)的电冲动传导速度 ,以便确定AFL患者除了解剖结构上的异常外 ,是否伴有心房电生理方面的异常变化。方法 1 0例AFL患者 ,男性 7例 ,女性 3例 ,平均 (53± 1 0 )岁 ;1 3例AVNRT患者 ,男性 5例 ,女性 8例 ,平均 (51± 1 1 )岁。对这两组患者进行了详细的电 解剖标测、电生理检查和射频消融术。分别以周长为 60 0、40 0、和 30 0ms在冠状静脉窦 (CS)起搏的情况下测量AFL和AVNRT患者的CTI和AS的冲动传导速度 ,并将两组患者在CTI和AS的冲动传导速度进行比较。结果 与AVNRT患者相比 ,AFL患者在各个起搏周长 (PCL)时CTI和AS的冲动传导速度都明显减慢 (P <0 0 5)。另外 ,在AFL组 ,AS的冲动传导速度在起搏周长 60 0、40 0ms时低于CTI,但在 30 0ms时差异无显著性 (P >0 0 5)。因为在AFL组 ,PCL为 30 0ms时的冲动传导速度明显低于 60 0和 40 0ms时的冲动传导速度 ,致使PCL为 30 0ms时CTI和AS的冲动传导速度差异无显著性。结论 与CTI相比 ,AS的冲动传导速度在所有患者都较慢 ,而AFL患者在CTI和AS的冲动传导速度减低更明显 。
Objectives To evaluate and compar e the effects of different heart rate on conduction velocity in the cavo-tricus pid isthmus (CTI) and the atrial septum (AS) in patients with and without atrial flutter (AFL) using electro-anatomic mapping (EAM) of the right atrium.Methods Ten patien ts [age(53±10) yrs,7M/3F] with AFL and 13 patients [(51±11) yrs,5M/8F] wit h atrio-ventricular nodal reentrant tachycardias (AVNRT) underwent conventional electrophysiological study,EAM and radiofrequency ablation.During coronary sinu s pacing at pacing cycle length (PCL) 600 ms,400 ms,and 300 m s seperately,the conduction velocities in the CTI and AS of the right atrium in 10 patients with AFL were evaluated using EAM and compared to that of 13 patient s with AVNRT to determine whether the conduction slowing is required t o maintain AFL in addition to anatomic obstacles electrophysiology. Results Conduction velocities in CTI and AS were significantly slower at all PCL when AFL was compared to AVNRT ( P <005). Additionally,in the A FL group,AS conduction velocities were s lower at PCL 600 ms and 400 ms( P <005),but not at 300 ms compared to CTI.I n AFL,during PCL 300 ms,conduction in CTI slowed significantly compared to P CL 600 and 400 ms,however,there was no difference between CTI and AS at PCL 300 ms.Conclusions There is slower conduction in the AS compa red to the CTI in all patients.However,in patients with AFL,there is significant slowing of conduction in the CTI and AS as well as decremental rate-dependent slowing of conduction in the CTI.These findings indicate that in addition to the right atrium enlargement,changes in atrial electrophysiology distinguish AFL pa tients from patients with AVNRT.
出处
《中华心律失常学杂志》
2003年第2期91-95,共5页
Chinese Journal of Cardiac Arrhythmias
