Belhassen B, Fish R, Eldar M, Glick A, Glikson M, Viskin S
Department of Cardiology, Tel-Aviv Sourasky Medical Center, Israel.
J Cardiovasc Electrophysiol. 2000 Mar;11(3):255-61. doi: 10.1111/j.1540-8167.2000.tb01794.x.
We recently reported that administration of adenosine triphosphate (ATP) during sinus rhythm identifies dual AV nodal physiology (DAVNP) in 76% of patients with inducible sustained AV nodal reentrant tachycardia (AVNRT) at electrophysiologic (EP) study. In that report, however, the ATP test was considered positive for DAVNP only when the results were reproducible at a given dose of ATP. The aim of the present study was to assess the value of a simplified ATP test for noninvasive diagnosis of DAVNP and abolition or modification of the slow pathway (SP) after radiofrequency ablation (RFA) in patients with inducible sustained AVNRT.
The value of a single dose of ATP was studied in 105 patients with inducible sustained AVNRT and in 31 control patients before placement of EP catheters in the cardiac chambers. ATP (10 to 60 mg, in 10-mg increments) was injected during sinus rhythm until ECG signs of DAVNP (> or = 50 msec increase or decrease in PR interval in two consecutive beats, or occurrence of > or = 1 AV nodal echo beat) or > or = second-degree AV block was observed. DAVNP was observed in only 1 (3.2%) control patient. The test could be completed in 96 study patients. DAVNP was found by ATP test in 72 (75%) patients, whereas it was diagnosed by EP criteria in 82 (85%) patients. DAVNP by ATP test disappeared in 27 (96%) of 28 patients who underwent SP abolition and in 18 (60%) of 30 patients who underwent SP modification. In the 12 patients with persistent DAVNP determined by ATP test after SP modification, the number of beats conducted over the SP was significantly reduced (from 6.3+/-3.3 to 2.5+/-2.2 beats; P = 0.002).
A single administration of ATP during sinus rhythm (at a given dose) enables noninvasive diagnosis of DAVNP in a high percentage of patients with inducible AVNRT and reliably confirms the results of RFA of the SP.
我们最近报道，在窦性心律时给予三磷酸腺苷（ATP），在电生理（EP）研究中可在76%的可诱发持续性房室结折返性心动过速（AVNRT）患者中识别出双房室结生理现象（DAVNP）。然而，在该报告中，只有当ATP给定剂量的结果可重复时，ATP试验才被认为DAVNP阳性。本研究的目的是评估简化的ATP试验在可诱发持续性AVNRT患者中对DAVNP进行无创诊断以及在射频消融（RFA）后对慢径路（SP）进行消融或改良的价值。
在105例可诱发持续性AVNRT的患者和31例对照患者中，在将EP导管置入心腔之前，研究了单剂量ATP的价值。在窦性心律时注射ATP（10至60mg，每次增加10mg），直至观察到DAVNP的心电图征象（连续两个心动周期的PR间期增加或减少≥50毫秒，或出现≥1次房室结回波搏动）或≥二度房室传导阻滞。仅在1例（3.2%）对照患者中观察到DAVNP。96例研究患者可完成该试验。通过ATP试验在72例（75%）患者中发现了DAVNP，而根据EP标准在82例（85%）患者中诊断出DAVNP。在接受SP消融的28例患者中的27例（96%）以及接受SP改良的30例患者中的18例（60%）中，ATP试验发现的DAVNP消失。在SP改良后通过ATP试验确定仍存在DAVNP的12例患者中，经SP传导的搏动次数显著减少（从6.3±3.3次降至2.5±2.2次；P = 0.002）。
在窦性心律时单次给予ATP（给定剂量）能够在高比例的可诱发AVNRT患者中对DAVNP进行无创诊断，并可靠地证实SP的RFA结果。
