Tai C T, Chen S A, Chiang C E, Lee S H, Wen Z C, Chiou C W, Ueng K C, Chen Y J, Yu W C, Huang J L, Chang M S
Division of Cardiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
Circulation. 1997 Jun 3;95(11):2541-7. doi: 10.1161/01.cir.95.11.2541.
Although typical atrioventricular nodal reentrant tachycardia (AVNRT) with discontinuous AV node function curves has been well studied, there has been a lack of any significant information about AVNRT without evidence of dual AV nodal pathway physiology during atrial extrastimulus testing or atrial pacing.
Group 1 included 9 patients with continuous curves during atrial extrastimulus testing but without a jump (> or = 50 ms) of the atrial-His bundle (AH) interval during incremental atrial pacing. The maximal AH interval during atrial pacing (266 +/- 61 versus 168 +/- 27 ms, P = .007) or extrastimulus testing (290 +/- 60 versus 176 +/- 18 ms, P = .005) shortened significantly after ablation. Antegrade and retrograde AV node properties were similar before and after ablation. Group 2 included 14 patients with continuous curves and a jump of the AH interval during incremental atrial pacing. The atrial pacing cycle length with 1:1 AV conduction and effective refractory period (ERP) of the antegrade AV node increased significantly, whereas the maximal AH interval during atrial pacing (358 +/- 70 versus 203 +/- 28 ms, P = .001) or extrastimulus testing (338 +/- 75 versus 196 +/- 34 ms, P = .002) shortened significantly after ablation. Group 3 included 24 patients with discontinuous curves. The maximal AH interval during atrial pacing or extrastimulus testing and the ERP of the antegrade fast AV node shortened, whereas the ERP of the antegrade AV node increased significantly after ablation. The maximal AH interval before ablation, extent of decrease in maximal AH interval after ablation, ERP of the retrograde AV node before ablation, and tachycardia cycle length were significantly shorter in group 1 than groups 2 and 3.
In AVNRT with continuous AV node function curves, dual AV nodal pathway physiology may or may not be demonstrated during atrial pacing. Significant shortening of the maximal AH interval during atrial pacing after radiofrequency ablation suggests successful elimination of AVNRT.
尽管具有不连续房室结功能曲线的典型房室结折返性心动过速（AVNRT）已得到充分研究，但在心房期外刺激试验或心房起搏期间，对于无房室结双径路生理证据的AVNRT却缺乏重要信息。
第1组包括9例在心房期外刺激试验期间曲线连续，但在递增性心房起搏期间房室结-希氏束（AH）间期无跳跃（≥50毫秒）的患者。消融后，心房起搏期间的最大AH间期（266±61对168±27毫秒，P = 0.007）或期外刺激试验期间的最大AH间期（290±60对176±18毫秒，P = 0.005）显著缩短。消融前后的房室结前传和逆传特性相似。第2组包括14例曲线连续且在递增性心房起搏期间AH间期有跳跃的患者。消融后，1:1房室传导的心房起搏周期长度和顺向房室结有效不应期（ERP）显著增加，而心房起搏期间的最大AH间期（358±70对203±28毫秒，P = 0.001）或期外刺激试验期间的最大AH间期（338±75对196±34毫秒，P = 0.002）显著缩短。第3组包括24例曲线不连续的患者。消融后，心房起搏或期外刺激试验期间的最大AH间期和顺向快速房室结ERP缩短，而顺向房室结ERP显著增加。第1组消融前的最大AH间期、消融后最大AH间期的缩短程度、消融前逆传房室结ERP和心动过速周期长度显著短于第2组和第3组。
在房室结功能曲线连续的AVNRT中，心房起搏期间可能显示或不显示房室结双径路生理。射频消融后心房起搏期间最大AH间期显著缩短提示成功消除AVNRT。
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