Fenici R, Ruggieri M P, di Lillo M, Fenici P
Catholic University of Rome, Italy.
Pacing Clin Electrophysiol. 1996 Nov;19(11 Pt 2):1951-7. doi: 10.1111/j.1540-8159.1996.tb03260.x.
The purpose of this study was to assess, in patients with ventricular preexcitation, the time dependent physiological variation of antegrade conduction properties in the AV node and in accessory pathways (Aps) as a function of autonomic tone variation induced by posture and physical effort, using noninvasive transesophageal atrial pacing. In 74 WPW patients (mean age 21.31 +/- 9.46 yrs), AV node and Kent antegrade effective refractory periods (at pacing cycle lengths 600, 400, and 320 ms), Wenckebach point, shortest preexcited RR intervals during sustained atrial fibrillation (AF) or atrial pacing, as well as the inducibility of AV reentry tachycardia (AVRT) and AF/flutter (AFL) were assessed. All measurements were carried out at rest, in supine and upright positions, and during effort. A second study was carried out approximately 3 months after the first study. The coefficient of variation (CVs) and reproducibility (CRs) were calculated. For each parameter, the differences between the mean of the two studies were not statistically significant. The CVs and CRs ranged between 0.4% and 4% and between 2 and 28 ms, respectively. AF was induced in 40 (54%) of 74 patients at the first study and in 30 (40.5%) of 74 patients at the second study. AVRT was induced in 33 (45%) of 74 patients at the first study and in 38 (51.3%) of 74 patients at the second study. The reproducibility was 45% for AF/AFL and 65% for reentry tachycardia. Transesophageal atrial pacing is a reliable method for noninvasive reproducible evaluation of antegrade electrophysiological properties of both the AV node and APs in WPW patients. However, the effect of autonomic balance variation has to be taken into account and precisely defined because it may significantly affect the inducibility of supraventricular arrhythmias and the estimation of the absolute values of the vulnerable parameters.
本研究的目的是，在心室预激患者中，使用无创经食管心房起搏，评估房室结和旁路（APs）中前向传导特性随时间的生理变化，该变化是由体位和体力活动引起的自主神经张力变化的函数。在74例预激综合征（WPW）患者（平均年龄21.31±9.46岁）中，评估了房室结和肯特束的前向有效不应期（起搏周期长度为600、400和320毫秒时）、文氏点、持续性心房颤动（AF）或心房起搏期间最短的预激RR间期，以及房室折返性心动过速（AVRT）和AF/心房扑动（AFL）的诱发情况。所有测量均在静息状态下、仰卧位和直立位以及体力活动期间进行。在首次研究约3个月后进行了第二项研究。计算了变异系数（CVs）和重复性（CRs）。对于每个参数，两项研究的平均值之间的差异无统计学意义。CVs和CRs分别在0.4%至4%和2至28毫秒之间。在首次研究中，74例患者中有40例（54%）诱发出AF，在第二项研究中，74例患者中有30例（40.5%）诱发出AF。在首次研究中，74例患者中有33例（45%）诱发出AVRT，在第二项研究中，74例患者中有38例（51.3%）诱发出AVRT。AF/AFL的重复性为45%，折返性心动过速的重复性为65%。经食管心房起搏是一种可靠的方法，可用于无创性重复评估WPW患者房室结和APs的前向电生理特性。然而，必须考虑并精确界定自主神经平衡变化的影响，因为它可能会显著影响室上性心律失常的诱发情况以及对易损参数绝对值的估计。
