摘要
目的 揭示在房室结折返性心动过速 (AVNRT)的选择性慢径消融时出现的加速性结区心律与消融靶点以及心动过速复发之间的关系 ,并为临床提供参考。方法 将 2 4 7例AVNRT病人按选择性慢径消融后心动过速的复发与否可将病人分为组 1(消融成功组 ,共 2 12例 )和组 2 (心动过速复发组 ,共 35例 )。将在慢径消融过程中出现的结区反应按其特点分为Ⅰ型 (放电后出现持续的结区反应 ,停止放电后即刻或间隔数秒恢复窦性心律 )和Ⅱ型 (放电后出现间歇性结区反应即窦性心律与结区心律交替出现 ,停止放电后可迅速恢复窦性心律 )。结果 组 1的结区反应较好 ,多为Ⅱ型表现 ;而组 2则多无结区反应 ,且其结区反应多呈Ⅰ型。另外 ,复发组中其结区反应出现的时间也相对较晚 [(3 2± 1 8)比 (5 7± 2 5 ) ,P <0 0 5 ]。而在成功消融组中其结区反应出现较早 ,且放电时结区心律与窦性心律交替出现 ,停止放电后窦律恢复较快 ,继续巩固放电时结区心律持续的时间逐渐缩短直至完全消失。而放电时若无结区反应 ,则消融的成功率并不高 (仅为 38% )。结论 在AVNRT病人的慢径消融过程中加速性结区心律尤其是Ⅱ型结区心律的出现 ,对于慢径的靶点选择具有重要的指导意义。
Objective Accelerated junctional rhythm (AJR) always occur during slow pathway catheter ablation for atrioventricular nodal reentrant tachycardia (AVNRT), the clinical significance of it has not been gotten in agreement. The aim of this study is to search for an association between AJR and ablation target site or tachycardia recurrence.Methods The data of 247 patients with AVNRT who received radiofrequency ablation procedure during April 1995 to October 1999 was analyzed. All these people were divided into two groups (212 patients in the successful ablation group or group 1, 35 patients in the recurrence group or group 2). The AJR was divided into two distinct pattern:type Ⅰ(continuous AJR that persisted until the end of energy delivery) and type Ⅱ (intermit AJR alternated with sinus rhythm during slow pathway ablation, which was eliminated immediately when stopping energy delivery ). Results\ The results showed that patients in group 1 exhibited better AJR response, most of them were seen with type Ⅱ AJR. However most of the people in group 2 had no AJR response throughout energy delivery , few of them had type Ⅰ AJR response. The AJR response of group 1 started relatively earlier than that of group 2(3 2±1 8 vs 5 7±2 5 ,P<0 05), AJR and sinus rhythm alternatively occurred during energy delivery, and AJR ended abruptly when stopping the energy application, which will be eliminated completely during the booster ablation. We also found that if there was no AJR response during energy delivery, the successful rate of slow pathway ablation would be very low ( only 38%). Conclusion AJR especially Ⅱ pattern during slow pathway ablation for patients with AVNRT may have very important significance in selecting successful slow pathway ablation site, Ⅱ pattern of AJR may be used as marker of successful slow pathway ablation target site in patients with AVNRT during radiofrequency catheter ablation.
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2002年第8期466-468,共3页
Chinese Journal of Practical Internal Medicine
关键词
临床意义
房室结折返性心动过速
慢径消融
加速性结区心律
有效消融靶点
Atroiventricular nodal reentrant tarchycardia (AVNRT) Slow pathway ablation\ Accelerated junctional rhythm Successful ablation site
