【摘要】 目的:探讨希氏束旁起搏鉴别间隔部隐匿性房室旁道与慢-快型房室结折返性心动过速(AVNRT)的临床价值.方法:采用希氏束逆传不应期心室早搏刺激法将61例患者分别诊断为37例慢-快AVNRT和24例间隔部房室折返性心动过速(AVRT);再对61例患者采用希氏束旁起搏方法进一步检测.结果:采用希氏束旁起搏法检测37例AVNRT患者中有6例未检测成功,其余31例均为逆传房室结图形;24例AVRT患者中4例未检测成功,15例呈逆传旁道/旁道图形,5例呈非逆传旁道/旁道图形.如以逆传旁道/旁道图形为标准,鉴别间隔快旁路引起的AVRT与慢-快型房室结折返性心动过速,敏感性75%,特异性可达100%.结论:希氏束旁刺激法对鉴别诊断AVRT与AVNRT有较高的特异性.更多还原

【Abstract】 Objective: To investigate the value of Para-Hisian Pacing in distinguishing concealed septal pathway from slow-fast atrioventricular nodal reentrant tachycardia(AVNRT). Methods: All 61 patients were devided into 37 patients with slow-fast AVNRT and 24 patients with atrioventriular reentrant tachycardia(AVRT) using concealed septal accessory pathway by ventricular extra-stimuli during tachycardia and His bundle refractory. All 61 patients underwent invasive electrophysiological studies, including Para-Hisian Pacing methods. Results: During Para-Hisian Pacing, 31/37 AVNRT show retrograde atrial activation only from atrioventricular node (retrograde from atrioventricular node map); 15/24 AVRT (septal pathway) observed retrograde atrial activation only from pathway (retrograde pathway/ pathway map). 5/24 AVRT (septal pathway) displayed non-retrograde pathway/ pathway map. Para-Hisian Pacing method was performed unsuccessfully in 6/37 AVNRT and 4/24 AVRT with septal concealed pathway. Para-Hisian Pacing (with retrograde pathway/ pathway map as distinguishing standard) can distinguish AVRT using concealed septal fast pathway from slow-fast AVNRT, sensitivity 75%, specificity 100%. Conclusions: Para-Hisian Pacing can diagnose AVRT (septal pathway) and distinguish AVRT using concealed septal fast pathway from slow-fast AVNRT with very high specificity.更多还原