Pasquié Jean Luc, Scalzi Joseph, Macia Jean Christophe, Leclercq Florence, Grolleau-Raoux Robert
Service de Cardiologie A, Hopital Arnaud de Villeneuve, Centre Hospitalier Universitaire, Montpellier, France.
Europace. 2006 Feb;8(2):129-33. doi: 10.1093/europace/euj037. Epub 2006 Jan 10.
The association of atrioventricular nodal re-entrant tachycardia (AVNRT) and pre-existing prolonged PR interval is unusual. Radiofrequency (RF) ablation in such patients may be associated with an increased risk of immediate and delayed AV block. The aim of our study is to assess the long-term efficacy and safety of slow pathway ablation in this population. We studied 10 patients (4 males and 6 females) with pre-existing prolonged PR interval of 68 consecutive patients with AVNRT. All had slow-fast subtype of AVNRT. The mean PR interval was 222 +/- 15 ms before RF. The patients with pre-existing prolonged PR were older (69 +/- 15 vs. 54 +/- 17, P = 0.008) and their tachycardias were slower (387 +/- 102 vs. 323 +/- 73 ms; P < 0.05). Transient complete AV block (<5 s) occurred in two patients. None had permanent complete AV block. One patient had a significant increase in PR interval (from 220 to 320 ms). The mean post-RF PR interval was 232+/-37 ms (P = n.s.). Over a mean follow-up of 39 +/- 21 months, none had a recurrence of tachycardia nor developed higher degree AV block. In conclusion, in patients with AVNRT and pre-existing prolonged PR interval, a slow pathway ablation appeared efficient and safe. From our data, no delayed AV block developed on a long follow-up. Most of the patients with periprocedural transient AV block had no evidence of dual AV node physiology, suggesting that, in this population, absence of dual AV node physiology may be associated with a higher risk of AV block during slow pathway ablation.
房室结折返性心动过速（AVNRT）与既往存在的PR间期延长相关的情况并不常见。在此类患者中进行射频（RF）消融可能会增加即刻和延迟性房室传导阻滞的风险。我们研究的目的是评估在这一人群中慢径路消融的长期疗效和安全性。我们研究了68例连续性AVNRT患者中10例（4例男性和6例女性）既往存在PR间期延长的患者。所有患者均为慢-快型AVNRT。射频消融术前平均PR间期为222±15毫秒。既往PR间期延长的患者年龄较大（69±15岁对54±17岁，P = 0.008），且其心动过速较慢（387±102毫秒对323±73毫秒；P < 0.05）。2例患者出现短暂性完全性房室传导阻滞（<5秒）。无一例发生永久性完全性房室传导阻滞。1例患者PR间期显著增加（从220毫秒增至320毫秒）。射频消融术后平均PR间期为232±37毫秒（P = 无统计学意义）。平均随访39±21个月期间，无一例心动过速复发，也未发生更高程度的房室传导阻滞。总之，对于AVNRT且既往存在PR间期延长的患者，慢径路消融似乎有效且安全。根据我们的数据，长期随访未出现延迟性房室传导阻滞。大多数围手术期出现短暂性房室传导阻滞的患者无房室结双径路生理证据，提示在这一人群中，不存在房室结双径路生理可能与慢径路消融期间房室传导阻滞风险较高相关。
