Kantharia Bharat K, Padder Farooq A, Kutalek Steven P
Department of Internal Medicine, Division of Cardiac Electrophysiology, Cardiac Electrophysiology Fellowship Training Program, Cardiac Electrophysiology Laboratories, Ohio State University Medical Center, Columbus, Ohio 43210, USA.
Pacing Clin Electrophysiol. 2006 Oct;29(10):1096-104. doi: 10.1111/j.1540-8159.2006.00503.x.
The primary aim of this study was to evaluate the utility of decremental ramp atrial extrastimuli pacing protocol (PRTCL) for induction of atrioventricular nodal re-entrant tachycardia (AVNRT), and other supraventricular tachycardias (SVTs), compared to standard (STD) methods.
The study cohort of 121 patients (age 57.51 +/- 14.02 years) who presented with documented SVTs and/or symptoms of palpitations and dizziness, and underwent invasive electrophysiological evaluation was divided into Group I (AVNRT, n = 42) and Group II (Control, n = 79). The PRTCL involved a train of six atrial extrastimuli, delivered in a decremental ramp fashion. The STD methods included continuous burst and rapid incremental pacing up to atrioventricular (AV) block cycle length, and single and occasionally double atrial extrastimuli. Prolongation in the Atrio-Hisian (Delta-AH) intervals achieved by both methods were compared, as were induction frequencies.
In Group I, three categories of responses--(1) induction of AVNRT, (2) induction of echo beats only, and (3) none--were observed in 29 (69%), 11 (26%), and 2 (5%) patients with the PRTCL, when compared with 14 (33%), 16 (38%), and 12 (29%) patients with STD methods in the baseline state without the use of pharmacological agents. The Delta-AH intervals for each of these three categories were larger using PRTCL versus STD methods; 293.3 +/- 95.2 ms versus 192.9 +/- 61.4 ms (P < 0.005), 308.6 +/- 68.5 ms versus 189. 9 +/- 64.9 ms (P < 0.0005), and 203.0 +/- 86.3 ms versus 145.8 +/- 58.9 ms (P = NS), respectively. In Group II, in one patient with dual AV nodal physiology but no clinical tachycardia, the PRTCL induced nonsustained (12 beats) AVNRT. Additionally, in this group, both PRTCL and STD methods induced atrial tachycardia in two patients and orthodromic AV re-entrant tachycardia in one patient.
Decremental ramp atrial extrastimuli pacing PRTCL demonstrates a superior response for induction of typical AVNRT as compared to STD techniques. Because of easy and reliable induction of AVNRT and echo beats by the PRTCL, we recommend it as a method to increase the likelihood of induction of AVNRT. For induction of other SVTs, the PRTCL and the STD methods are comparable.
本研究的主要目的是评估递减式心房额外刺激起搏方案（PRTCL）与标准（STD）方法相比，在诱发房室结折返性心动过速（AVNRT）及其他室上性心动过速（SVT）方面的效用。
研究队列包括121例患者（年龄57.51±14.02岁），这些患者有记录的室上性心动过速和/或心悸、头晕症状，并接受了有创电生理评估，分为I组（AVNRT，n = 42）和II组（对照组，n = 79）。PRTCL包括以递减方式发放一串6个心房额外刺激。STD方法包括持续猝发和快速递增起搏直至房室（AV）阻滞周期长度，以及单个和偶尔的双心房额外刺激。比较两种方法实现的心房 - 希氏束（Delta - AH）间期延长以及诱发频率。
在I组中，采用PRTCL时，29例（69%）、11例（26%）和2例（5%）患者分别出现三类反应——（1）诱发AVNRT，（2）仅诱发回波搏动，（3）无反应，而在未使用药物的基线状态下，采用STD方法的患者分别为14例（33%）、16例（38%）和12例（29%）。与STD方法相比，PRTCL用于这三类反应时的Delta - AH间期均更长；分别为293.3±95.2毫秒对192.9±61.4毫秒（P < 0.005），308.6±68.5毫秒对189.9±64.9毫秒（P < 0.0005），以及203.0±86.3毫秒对145.8±58.9毫秒（P =无显著性差异）。在II组中，1例具有双房室结生理但无临床心动过速的患者，PRTCL诱发了非持续性（12次搏动）AVNRT。此外，在该组中，PRTCL和STD方法均在2例患者中诱发了房性心动过速，在1例患者中诱发了顺向性房室折返性心动过速。
与STD技术相比，递减式心房额外刺激起搏PRTCL在诱发典型AVNRT方面显示出更好的反应。由于PRTCL能简便可靠地诱发AVNRT和回波搏动，我们推荐将其作为增加AVNRT诱发可能性的一种方法。对于诱发其他室上性心动过速，PRTCL和STD方法相当。
