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1、中国心脏起搏与心电生理杂志1996年第10卷第3期·125·õ临床论著õ房室慢旁道的电生理表现及射频消融治疗黄从新江洪唐其柱李庚山陈芳(湖北医科大学附属第一医院心内科武汉430060)摘要报道射频导管消融(RFCA)治疗慢旁道参与的房室折返性心动过速患者11例。电生理检查和静脉注射ATP(7例)试验发现:¹增频刺激右室心尖部时,VA文氏点为183.2±22.6(160~230)bpm,达1÷1室房传导的最高刺激频率时最早心房激动部位的室房传导时间较基础频率刺激时最早心房激动部位的室房传导时间(BVAE)延长68.8±29.8
2、(46~109)ms,P<0.01。心室程控刺激时旁道阻滞前最早心房激动部位的室房传导时间较BVAE延长107.6±41.8ms,P<0.01,表明慢旁道传导表现为传导速度慢以及出现频率依赖性递减传导和文氏阻滞。º连续心室刺激时静脉注射ATP7例中有5例于注射后20.6±2.0(18~23)s出现完全性室房阻滞,另2例室房传导时间逐渐延长。提示ATP可使慢旁道的室房传导发生阻滞或传导时间延长。»心动过速时逆传激动顺序异常,与H波同步刺激心室均能夺获心房。¼RFCA可成功阻断慢旁道,有效靶点的室房传导时间为133.6±21.1
3、(128~160)ms,A波超前最早参照点为26.4±8.4(20~40)ms,有效靶点逆传房波前有旁道电位。结论:上述结果提示慢旁道的电生理特点和组织结构可能不同于普通旁道;RFCA治疗具有较好的效果。关键词慢旁道电生理特性ATP试验导管消融,射频电流TheElectrophysiologicCharacteristicsofSlowAtrioventricularAccessoryPathwaysandItsManagementWithRadiofrequencyCatheterAblationHuangCongxin,
4、JiangHong,TangQizhu,etal(DepartmentofCardiology,FirstAffiliatedHospitalofHubeiMedicalUniversity,Wuhan,430060)AbstractElevenpatientswithatrioventricularreentranttachycardiacausedbyslowatrioventricularaccessorypathways(slowAP)weretreatedwithradiofrequencycatheterabla
5、tion(RFCA).AllofthemunderwentdetailelectrophysiologictestandsevenofthemreceivedATPintravenousinfusionbeforeRFCA.Itwasfoundthat:(1)duringrightventricularapex(RVA)incrementalstimulation,theVAWenckebachblockpointoftheslowAPwas183.2±22.6(160~230)bpmandVAconductiontimem
6、easuredfromtheearliestatrialsiteatthemostrapidstim-ulationratethatcouldcause1÷1VAconduction(MVAE)was68.8±29.8(46~109)mslongerthanthatmea-suredatbasicstimulationrate[(BVAE),P<0.01],duringS1S2stimulationfromRVAtheVAconductiontimemueasuredjustbeforeS2couldnotcauseVAco
7、nduction(MV2AE)was107.6±41.8mslongerthanBVAE(P<0.01),allofthesesuggestedlowAPhadlowconductionspeed,rate-dependentconductionandWenckebachcon-ductionblock.(2)ATPcouldcauseVAconductionblockorprolongationofconductiontimeduringventricularpac-ingandgivingATPintravenousin
8、fusion,whichcausedVAblockin5patientsandVAdelayinanothertwopa-tientsafter20.6±2.0(18~25)s.(3)theyhadabnormalatrialactivitysiteduringtachycardiaand