【摘要】 目的　探讨慢慢型房室结折返性心动过速 (AVNRT)的电生理机制和不同射频导管消融方法的治疗效果。方法　812例AVNRT患者分为两组,第 1组 500例,比较慢慢型中前传慢径和逆传慢径的成功消融部位的异同、比较在慢慢型和快慢型中选择性地消融逆传慢径部位的异同。第 2组312例,在设想慢慢型AVNRT折返机制的基础上,前瞻性地对慢慢型仅选择性消融前传慢径而不消融逆传慢径。结果　第 1组 59例慢慢型AVNRT的前传和逆传慢径的传导时间和成功消融的部位明显不同,逆传慢径多在冠状静脉窦(CS)窦口内或CS近端消融成功,而前传慢径多在三尖瓣环和CS窦口之间消融成功;慢慢型与快慢型的逆传慢径有明显不同的传导时间、递减特性和解剖分布。在第 2组前瞻性地仅消融前传慢径治疗 22例慢慢型组中,在三尖瓣环和CS窦口之间成功消融前传慢径并治愈AVN RT后, 21例逆传慢径功能不变,其逆传慢径最早心房插入点部位与前传慢径消融部位不同。所有 812例AVNRT均消融成功,第 1组在 3年以上的随访中, 387例慢快型复发 1例 (0 3% ), 59例慢慢型复发6例(10% ), 54例快慢型无复发。第 2组 312例 3 ~48 ( 23±12 )个月的随访中,慢快型复发 2例(0 5% ),慢慢型和快慢型无复发。结论　(1)慢慢型AVNRT应用电生理特性和解剖分布不同的两条慢径形?更多还原

【Abstract】 Objective To investigate the electrophysiologic mechanism and the effect of radiofrequency catheter ablation in slow/slow form of atrioventricular nodal reentrant tachycardia(AVNRT).Methods Eight hundred and twelve patients with AVNRT referred for ablation were divided into 2 groups.Group 1 consisted of 500 patients.The electrophysiologic properties and the sites with successful ablation between the retrograde slow pathway(retro-SP)and the antegrade SP(ante-SP)in slow/slow AVNRT were compared,and the successful ablation sites of (retro-SP) between slow/slow and fast/slow AVNRT were also compared.In group 1 patients with slow/slow AVNRT,the (retro-SP) was initially ablated. Group 2 consisted of 312 patients.Based on the hypothesis of the reentrant circuit for slow/slow AVNRT,the ante-SP was prospectively ablated by electroanatomic guided approach despite the existence of the (retro-SP) in slow/slow AVNRT,and the successful ablation site for ante-SP and the earliest atrial insertion site of (retro-SP) were compared.Results In group 1,59 patients had slow/slow AVNRT and 54 patients had fast/slow AVNRT.In slow/slow AVNRT,the (ante-SP) and (retro-SP) conduction time during tachycardia and the successful ablation sites between ante-SP and (retro-SP) were significantly different.The (retro-SP) was mostly ablated at the CS ostium or within the proximal CS and the ante-SP was mostly ablated between the tricuspid annulus and CS.The conduction time,the decremental properties and the successful ablation sites of the retro-SP between slow/slow and fast/slow AVNRT were all significantly different.In group 2,slow/slow AVNRTwas successfully eliminated in all 22 patients targeting the ante-SP by electroanatomic guided approach.After ablation of ante-SP,the retro-SP conduction had no change in 21 slow/slow AVNRT patients.During follow-up,6 of the 59 patients with slow/slow AVNRT in ( )group 1 had recurrence,and no recurrence in the 22 patients with slow/slow AVNRT in group 2.Conclusions (①In slow/slow) AVNRT,the ante-SP and (retro-SP) have markedly different electrophysiologic properties and anatomical distributions,and the anatomical substrates for the (ante-SP) and retro-SP are most likely the right posterior extension and the left posterior extension of the AV node respectively;②In slow/slow AVNRT,ablation of ante-SP using electroanatomic guided approach has a high successful rate and a low recurrence rate.更多还原