Wegner Felix K, Silvano Maria, Bögeholz Nils, Leitz Patrick R, Frommeyer Gerrit, Dechering Dirk G, Zellerhoff Stephan, Kochhäuser Simon, Lange Philipp S, Köbe Julia, Wasmer Kristina, Mönnig Gerold, Eckardt Lars, Pott Christian
Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany.
Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
J Cardiol. 2017 Feb;69(2):471-475. doi: 10.1016/j.jjcc.2016.02.011. Epub 2016 Mar 25.
Slow pathway modification (SPM) is the therapy of choice for AV-nodal reentry tachycardia (AVNRT). When AVNRT is not inducible, empirical ablation can be considered, however, the outcome in patients with two AV nodal echo beats (AVNEBs) is unknown.
Out of a population of 3003 patients who underwent slow pathway modification at our institution between 1993 and 2013, we retrospectively included 32 patients with a history of symptomatic tachycardia, lack of paroxysmal supraventricular tachycardia (pSVT) inducibility but occurrence of two AVNEBs.
pSVT documentation by electrocardiography (ECG) was present in 20 patients. The procedural endpoint was inducibility of less than two AVNEBs. This was reached in 31 (97%) patients. Long-term success was assessed by a telephone questionnaire (follow-up time 63±9 months). A total 94% of the patients benefited from the procedure (59% freedom from symptoms; 34% improvement in symptoms). Among those patients in whom ECG documentation was not present, 100% benefited (58% freedom from symptoms, 42% improvement).
This is the first collective analysis of a group of patients presenting with symptoms of pSVT and inducibility of only two AVNEBs. Procedural success and clinical long-term follow-up were in the range of the reported success rates of slow pathway modification of inducible AVNRT, independent of whether ECG documentation was present. Thus, SPM is a safe and effective therapy in patients with two AVNEBs.
慢径路改良术（SPM）是房室结折返性心动过速（AVNRT）的首选治疗方法。当不能诱发AVNRT时，可以考虑经验性消融，然而，有两个房室结回波搏动（AVNEBs）的患者的治疗结果尚不清楚。
在1993年至2013年间于我院接受慢径路改良术的3003例患者中，我们回顾性纳入了32例有症状性心动过速病史、不能诱发阵发性室上性心动过速（pSVT）但出现两个AVNEBs的患者。
20例患者通过心电图（ECG）记录到pSVT。手术终点是诱发的AVNEBs少于两个。31例（97%）患者达到了这一终点。通过电话问卷调查评估长期成功率（随访时间63±9个月）。总共94%的患者从该手术中获益（59%无症状；34%症状改善）。在那些没有ECG记录的患者中，100%获益（58%无症状，42%症状改善）。
这是对一组有pSVT症状且仅能诱发两个AVNEBs的患者的首次汇总分析。手术成功率和临床长期随访结果在已报道的可诱发AVNRT的慢径路改良术成功率范围内，与是否有ECG记录无关。因此，SPM对于有两个AVNEBs的患者是一种安全有效的治疗方法。
