Grecu Mihaela, Floria Mariana, Georgescu Catalina Arsenescu
Cardiovascular Diseases Institute Prof. Dr. George I.M. Georgescu, Iasi, Romania.
Pacing Clin Electrophysiol. 2009 Mar;32 Suppl 1:S98-100. doi: 10.1111/j.1540-8159.2008.02261.x.
We examined the possible role of atrioventricular node (AVN) conduction abnormalities as a cause of AVN reentrant tachycardia (RT) in patients >65 years of age.
Slow pathway radiofrequency catheter ablation (RFCA) was performed in 104 patients. Patients in group 1 (n = 14) were >65 years of age and had AV conduction abnormalities associated with structural heart disease. Patients in group 2 (n = 90) were <65 years of age and had lone AVNRT.
Patients in group 1 versus group 2 (66% vs. 46% men) had a first episode of tachycardia at an older age than in group 2 (68 +/- 16.8 vs 32.5 +/- 18.8 years, P = 0.007). The history of arrhythmia was shorter in group 1 (5.4 +/- 3.8 vs 17.5 +/- 14, P = 0.05) and was associated with a higher proportion of patients with underlying heart disease than in group 2 (79% vs 3%, P < 0.001). The electrophysiological measurements were significantly shorter in group 2: atrial-His interval (74 +/- 17 vs 144 +/- 44 ms, P = 0.005), His-ventricular (HV) interval (41 +/- 5 vs 57 +/- 7 ms, P = 0.001), Wenckebach cycle length (329 +/- 38 vs 436 +/- 90 ms, P = 0.001), slow pathway effective refractory period (268 +/- 7 vs 344 +/- 94 ms, P = 0.005), and tachycardia cycle length (332 +/- 53 vs 426 +/- 56 ms, P = 0.001). The ventriculoatrial block cycle length was similar in both groups. The immediate procedural success rate was 100% in both groups, and no complication was observed in either group. One patient in group 2 had recurrence of AVNRT. One patient with a 98-ms HV interval underwent permanent VVI pacemaker implantation before RFCA procedure.
In patients undergoing RFCA for AVNRT at >65 years of age had a shorter history of tachycardia-related symptoms than patients with lone AVNRT. The longer AVN conduction intervals and refractory period might explain the late development of AVNRT in group 1.
我们研究了房室结（AVN）传导异常作为65岁以上患者房室结折返性心动过速（RT）病因的可能作用。
对104例患者进行了慢径路射频导管消融（RFCA）。第1组（n = 14）患者年龄>65岁，伴有与结构性心脏病相关的房室传导异常。第2组（n = 90）患者年龄<65岁，患有孤立性房室结折返性心动过速。
与第2组相比，第1组患者（男性占66% vs. 46%）首次发生心动过速的年龄更大（68±16.8岁 vs 32.5±18.8岁，P = 0.007）。第1组患者的心律失常病史较短（5.4±3.8年 vs 17.5±14年，P = 0.05），且与潜在心脏病患者的比例高于第2组（79% vs 3%，P < 0.001）。第2组的电生理测量值明显更短：心房-希氏束间期（74±17 vs 144±44毫秒，P = 0.005）、希氏束-心室（HV）间期（41±5 vs 57±7毫秒，P = 0.001）、文氏周期长度（329±38 vs 436±90毫秒，P = 0.001）、慢径路有效不应期（268±7 vs 344±94毫秒，P = 0.005）以及心动过速周期长度（332±53 vs 426±56毫秒，P = 0.001）。两组的室房阻滞周期长度相似。两组的即刻手术成功率均为100%，且两组均未观察到并发症。第2组有1例患者发生房室结折返性心动过速复发。1例HV间期为98毫秒的患者在RFCA手术前接受了永久性VVI起搏器植入。
与孤立性房室结折返性心动过速患者相比，65岁以上接受RFCA治疗房室结折返性心动过速的患者与心动过速相关症状的病史较短。更长的房室结传导间期和不应期可能解释了第1组患者房室结折返性心动过速的晚发情况。
