Brignole M, Delise P, Menozzi C, Paparella N, Gianfranchi L, Themistoclakis S, Bonso A, Lolli G, Alboni P
Section of Arrhythmology, Ospedali Riuniti, Lavagna, Italy.
Eur Heart J. 1997 Jun;18(6):985-93. doi: 10.1093/oxfordjournals.eurheartj.a015388.
In patients with atrioventricular nodal re-entrant tachycardia, modifications of the antegrade atrioventricular nodal function curve caused by catheter ablation of the so-called slow pathway are heterogeneous, but have not yet been systematically evaluated.
To test the hypothesis that successful treatment is independent of specific electrophysiological modifications of atrioventricular nodal conducting properties.
Standard electrophysiological parameters and comparable antegrade atrioventricular nodal function curves were obtained, before and after successful ablation, in 104 patients (mean age 52 +/- 16 years: 69 women) affected by the common form of atrioventricular nodal re-entrant tachycardia.
Three different major patterns of antegrade atrioventricular nodal function curve were caused by ablation: downward shift of the curve with disappearance of atrioventricular nodal duality, suggesting the elimination of the slow pathway in 54 (52%) patients (type 1): absence of clear modifications of the curve (and of slow pathway ablation) in 33 (32%) patients (type 2); upward shift of the curve, suggesting a further slowing of conduction velocity through the slow pathway in 17 (16%) patients (type 3). Type-1 pattern was more frequent in patients < or = 45 years, whereas type-2 pattern was more frequent in those > 45 years.
Successful ablation of atrioventricular nodal re-entrant tachycardia is independent of specific modifications of antegrade atrioventricular conduction and probably depends on critical nodal and perinodal tissue damage at different sites on the re-entrant circuit. The effects of ablation are influenced by patient age.
在房室结折返性心动过速患者中，所谓慢径路导管消融引起的前向房室结功能曲线改变是异质性的，但尚未得到系统评估。
检验成功治疗与房室结传导特性的特定电生理改变无关这一假设。
在104例（平均年龄52±16岁；69例女性）常见形式的房室结折返性心动过速患者成功消融前后，获取标准电生理参数和可比的前向房室结功能曲线。
消融导致三种不同的主要前向房室结功能曲线模式：曲线下移且房室结双径路消失，提示54例（52%）患者慢径路被消除（1型）；33例（32%）患者曲线无明显改变（且慢径路未被消融）（2型）；曲线上升，提示17例（16%）患者通过慢径路的传导速度进一步减慢（3型）。1型模式在年龄≤45岁的患者中更常见，而2型模式在年龄＞45岁的患者中更常见。
房室结折返性心动过速的成功消融与前向房室传导的特定改变无关，可能取决于折返环不同部位关键的结内和结周组织损伤。消融效果受患者年龄影响。
