Schuger C D, Steinman R T, Meissner M D, Mosteller R D, Lehmann M H
Wayne State University, Detroit, Michigan.
Cardiol Clin. 1990 Aug;8(3):491-501.
A broad array of therapeutic options is currently available for the management of patients with AV nodal reentrant tachycardia. While acute termination of tachycardias is readily achieved, either by vagal maneuvers or intravenous medication, the decision to embark on a long-term therapeutic plan to prevent recurrences must be clinically individualized. When a chronic pharmacologic approach is desired, electrophysiologic testing is invaluable for confirming the diagnosis and selecting appropriate medication. However, the growing awareness of potential proarrhythmic effects and the inconvenience and expense of lifelong drug therapy, coupled with other advances in the field, have made nonpharmacologic approaches more attractive. This is especially so for symptomatic younger patients. The definitive cure rates achievable with surgery are now being approached by transcatheter AV nodal modification procedures that ablate AV nodal reentrant tachycardia while preserving anterograde AV nodal conduction. Over the next decade, it is likely that the latter technique will become widely used for the long-term management of symptomatic AV nodal reentrant tachycardia.
目前有多种治疗选择可用于房室结折返性心动过速患者的管理。虽然通过迷走神经手法或静脉用药很容易实现心动过速的急性终止，但开始长期治疗计划以预防复发的决定必须根据临床情况个体化。当希望采用慢性药物治疗方法时，电生理检查对于确诊和选择合适的药物非常有价值。然而，对潜在致心律失常作用的认识不断提高，以及终身药物治疗的不便和费用，再加上该领域的其他进展，使得非药物治疗方法更具吸引力。对于有症状的年轻患者尤其如此。手术可达到的根治率现在正被经导管房室结改良术所接近，该手术在保留房室结前向传导的同时消融房室结折返性心动过速。在未来十年，后一种技术可能会广泛用于有症状房室结折返性心动过速的长期管理。
