Osswald S, Buser P T, Rickenbacher P, Pfisterer M
Kardiologische Abteilung, Kantonsspital Basel.
Schweiz Med Wochenschr. 1996 Jun 1;126(22):974-85.
Most of the paroxysmal forms of supraventricular tachycardia are reentry tachycardias in origin with either an AV-nodal reentry (AVNRT; approx. 50%) or an AV reentry circuit via accessory pathway (AVRT; approx. 30%) as the anatomical basis of tachycardia. The therapeutic options include either drug therapy or transcatheter radiofrequency ablation. In asymptomatic patients, where supra-ventricular tachycardia or WPW syndrome was documented incidentally, an expectative approach without therapy is usually recommended. However, if frequent tachycardia recurrences or severe clinical symptoms (syncope, pre-syncope make treatment mandatory, medical therapy with either betablockers, calcium antagonists or digoxin should be tried if AV-nodal reentry tachycardia is the mechanism (no evidence of WPW syndrome on the 12-lead ECG). In patients with symptomatic WPW syndrome or drug refractory AV-nodal reentry tachycardia, transcatheter radiofrequency ablation with its good results and low complication rate is the therapy of choice. The treatment modality is particularly indicated in young patients who otherwise would need lifelong drug therapy. In contrast, supraventricular tachycardias with badly defined anatomical substrate, such as multifocal atrial tachycardias or atrial fibrillation, should in the first place be treated medically and not by radiofrequency ablation.
大多数阵发性室上性心动过速起源于折返性心动过速，其解剖学基础为房室结折返（房室结折返性心动过速，约占50%）或经旁路的房室折返环路（房室折返性心动过速，约占30%）。治疗选择包括药物治疗或经导管射频消融。对于无症状且偶然记录到室上性心动过速或预激综合征的患者，通常建议采取观察等待、不予治疗的方法。然而，如果心动过速频繁复发或出现严重临床症状（晕厥、先兆晕厥）则必须进行治疗，若机制为房室结折返性心动过速（12导联心电图无预激综合征证据），可尝试使用β受体阻滞剂、钙拮抗剂或地高辛进行药物治疗。对于有症状的预激综合征患者或药物难治性房室结折返性心动过速患者，经导管射频消融效果良好且并发症发生率低，是首选治疗方法。这种治疗方式特别适用于那些否则需要终身药物治疗的年轻患者。相比之下，解剖学基质不明确的室上性心动过速，如多源性房性心动过速或心房颤动，首先应进行药物治疗，而非射频消融。
