Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
Department of Cardiology-Electrophysiology, University Heart and Vascular Center, Hamburg, Germany.
Clin Res Cardiol. 2020 Aug;109(8):1025-1034. doi: 10.1007/s00392-020-01596-y. Epub 2020 Jan 30.
Supraventricular tachycardias induced by dual antegrade conduction via the atrioventricular (AV) node are rare but often misdiagnosed with severe consequences for the affected patients. As long-term follow-up in these patients was not available so far, this study investigates outcomes in patients with dual antegrade conduction in the AV node.
In this multicentre observational study, patients from six European centres were studied. Catheter ablation was performed in 17 patients (52 ± 16 years) with dual antegrade conduction via both AV nodal pathways between 2012 and 2018. Patients with the final diagnosis of a manifest dual AV nodal non-re-entrant tachycardia had a mean delay of the correct diagnosis of over 1 year (range 2-31 months). Two patients received prescription of non-indicated oral anticoagulation, two further patients suffered from inappropriate shocks of an implantable cardioverter defibrillator. In 12 patients, a co-existence of dual antegrade and re-entry conduction in the AV node was present. Mean fast pathway conduction time was 138 ± 61 ms and mean slow pathway conduction time was 593 ± 134 ms. Successful radiofrequency catheter ablation was performed in all patients. Post-procedurally oral anticoagulation was discontinued, without detection of cerebrovascular events or atrial fibrillation during a long-term follow-up of median 17 months (range 6-72 months).
This first multicentre study investigating patients with supraventricular tachycardia and dual antegrade conduction in the AV node demonstrates that catheter ablation is safe and effective while long-term patient outcome is good. Autonomic tone dependent changes in ante- vs. retrograde conduction via slow and/or fast pathway can challenge the diagnosis and therapy in some patients.
通过房室（AV）结的双顺传引发的室上性心动过速很少见，但常常误诊，对受影响的患者造成严重后果。由于这些患者目前还没有长期随访，因此本研究调查了 AV 结内双顺传患者的结局。
在这项多中心观察性研究中，研究了来自六个欧洲中心的患者。在 2012 年至 2018 年间，对 17 名（52±16 岁）通过 AV 结内的两条逆行途径发生双顺传的患者进行了导管消融。具有显性双 AV 结非折返性心动过速最终诊断的患者的正确诊断平均延迟超过 1 年（范围 2-31 个月）。两名患者接受了不必要的口服抗凝治疗，另外两名患者则因植入式心脏复律除颤器的不适当电击而受苦。在 12 名患者中，存在 AV 结内的双顺传和折返传导共存。快径传导时间平均为 138±61ms，慢径传导时间平均为 593±134ms。所有患者均成功进行了射频导管消融。在进行程序后，停用了口服抗凝药物，在长达 17 个月（6-72 个月）的长期随访期间，未发现脑血管事件或心房颤动。
这是第一项研究 AV 结内室上性心动过速和双顺传患者的多中心研究，表明导管消融是安全有效的，而长期患者结局良好。自主神经张力依赖性改变会影响慢径和/或快径前传与逆行传导，这在某些患者中可能会对诊断和治疗构成挑战。
