【摘要】 目的探讨选择性改良房室结慢径放电过程中预示三度房室传导阻滞(AVB)的新指标。方法回顾性分析2010年1月至l2月期间在广东省心血管病研究所完成的房室结折返性心动过速(AVNRT)经导管射频消融(RFCA)治疗的患者资料,统计放电过程中出现一过性三度房室传导阻滞的发生率,分析放电过程中出现一过性三度房室传导阻滞前的心电现象。结果经心内电生理检查诊断为房室结折返性心动过速的患者412例,慢快型347例,84.2%;快慢型45例,10.9%;慢慢型20例,4.9%。均采用选择性改良房室结慢径治疗,成功率100%。复发2例,复发率0.5%,均在第二次消融成功。永久性房室结折返性心动过速罹患率为0。一过性房室结折返性心动过速为7例,罹患率1.7%。出现早发交界心律31例,罹患率为7.5%。总共放电1406次,出现早发交界心律的放电67次,发生率4.8%。在出现早发交界心律的放电过程中,即刻停止放电组一过性房室结折返性心动过速发生率是2.3%;延迟停止放电组一过性房室结折返性心动过速发生率是25.0%;两组发生率比较,差异有统计学意义(P=0.013)。结论早发交界心律也是预示三度AVB的指标之一,出现早发交界心律即刻停止放电是避免房室结折返性心动过速的有效方法。更多还原

【Abstract】 Objectives To investigate the new predictor of third degree atrioventricular block (AVB) during energy delivery in treatment of atrioventricular nodal reentrant tachycardia (AVNRT) with selective slow pathway ablation.Methods The intact clinical data of patients with AVNRT treated by radiofrequency current catheter ablation (RFCA) in Guangdong Cardiovascular Institute from January to December in 2010 were collected.The attack rate of transient third degree AVB was counted.Endocardial electrogram before transient third degree AVB during energy delivery in treatment of AVNRT with selective slow pathway ablation were analyzed retrospectively.Results Four hundred and twelve patients were diagnosed AVNRT by electrophysiological study.There were 347 cases (84.2%) slow/fast form,45 cases (10.9%) fast/slow form,20 cases (4.9%) slow/slow form.All 412 patients of AVNRT were treated successfully with selective slow pathway ablation and the success rate was 100%.Two patients who recurred were succeeded in ablation again and the recurrent rate was 0.5%.The attack rate of permanent third degree AVB was 0.Seven patients were attacked by transient third degree AVB and the attack rate was 1.7%.Thirty one patients were found early junctional rhythm (junctional rhythm occurred within 5 seconds during energy delivery in RFCA),and the attack rate was 7.5%.Total energy delivery were 1 406 times,67 times of which occurred early junctional rhythm and the incidence rate was 4.8%.When early junctional rhythm was found in RFCA,radiofrequency energy was discontinued within 2 seconds in 43 times (group A) and more than 2 seconds in 24 times (group B).The incidence rate of transient third degree AVB was 2.3% in group A,and 25.0% in group B.Group B had a higher incidence rate of transient third degree AVB than group A (25.0% vs.2.3%,P=0.013).Conclusions Early junctional rhythm is one of the characteristic endocardial electrogram which is predictor of third degree AVB during energy delivery in treatment of AVNRT with selective slow pathway ablation.In order to avoid third degree AVB,energy delivery should be stop immediately once the early junctional rhythm occurred.更多还原