右中间隔心底部和心尖部刺激鉴别间隔部隐匿性房室旁道的作用To evaluate the value of right ventricular stimuli in right midseptal and apex in distinguishing septal fast pathway
姜述斌,吴忠东,帕尔哈提,许力舒,赵勤英
摘要(Abstract)：
目的评价右中间隔心底部和心尖部刺激对间隔隐匿性房室折返性心动过速(AVRT)的诊断价值。方法通过希氏束逆传不应期行心室早搏刺激法将142例患者分为74例慢-快型房室结折返性心动过速(AVNRT)和68例间隔隐匿性快旁道引起的AVRT患者,成功消融前均常规行腔内电生理检查,并在此基础上加用同频率右中间隔心底部和心尖部刺激:窦性心律时以120次/min的相同频率,分别刺激心尖和心底部,比较各自右心室的V波至逆传心房产生逆传A波的时限(VA)。结果希氏束逆传不应期行心室早搏刺激检测结果:心动过速时,希氏束逆传不应期内心室早搏刺激,74例快-慢型AVNRT患者心房激动不能提前(变化小于10ms),68例AVRT患者心房均被提前激动超过20ms(30～50ms)。同频率心尖部和右中间隔心底部刺激法检测结果:心尖部刺激所测的VA减去自身心底刺激所测的VA差值AVNRT患者为-65～6(-41±17)ms;间隔旁道引起的AVRT患者22～63(34±10)ms,两者间差异有统计学意义(P<0.01)。各例间隔旁道引起的AVRT患者的差值均大于10ms,各例AVNRT患者均小于10ms,两者间无重叠现象出现。5例AVNRT患者和3例间隔旁道引起的AVRT患者检测失败。结论窦性心律时同频率心尖部、右中间隔心底部起搏刺激法鉴别诊断AVRT和AVNRT的敏感性和特异性很高,而且操作简单,便于在临床上推广应用。
关键词(KeyWords)： 右中间隔心底部和心尖部刺激;间隔部快旁道;鉴别诊断
基金项目(Foundation):
作者(Author): 姜述斌,吴忠东,帕尔哈提,许力舒,赵勤英
参考文献(References)：
- [1]Martínez-Alday JD,Almendral J,Arenal A,et al.Identification of concealed posteroseptal Kent pathways by comparison of ventriculoatrial intervals from apical and posterobasal right ventricular sites.Circulation,1994,89:1060-1067.
- [2]邹建刚,黄元铸,廖铭扬,等.心室起搏对后间隔旁道与快径逆传的诊断价值.中国心脏起搏与电生理杂志,1996,10:136.
- [3]Lai LP,Lin JL,Wu MH,et al.Usefulness of intravenous propofol anesthesia for radiofrequency catheter ablation in patients with tachyarrhythmias:infeasibility for pediatric patients with ectopic atrial tachycardia.Pacing Clin Electrophysiol,1999,22:1358-1364.
- [4]O'Callaghan PA,Poloniecki J,Sosa-Suarez G,et al.Long-term clinical outcome of patients with prior myocardial infarction after palliative radiofrequency catheter ablation for frequent ventricular tachycardia.Am J Cardiol,2001,87:975-981.