无诱发心动过速的自发性室上性心动过速和双房室结通路患者慢径路导管消融的临床和电生理特征及长期疗效

Clinical and electrophysiologic characteristics and long-term efficacy of slow-pathway catheter ablation in patients with spontaneous supraventricular tachycardia and dual atrioventricular node pathways without inducible tachycardia.

作者信息

Lin J L, Stephen Huang S K, Lai L P, Ko W C, Tseng Y Z, Lien W P

机构信息

Department of Internal Medicine, National Taiwan University Hospital, Taipei.

出版信息

J Am Coll Cardiol. 1998 Mar 15;31(4):855-60. doi: 10.1016/s0735-1097(98)00015-1.

DOI:10.1016/s0735-1097(98)00015-1

PMID:9525559

Abstract

OBJECTIVES

We sought to investigate the long-term efficacy of slow-pathway catheter ablation in patients with spontaneous, documented paroxysmal supraventricular tachycardia (PSVT) and dual atrioventricular (AV) node pathways but without inducible tachycardia.

BACKGROUND

The lack of reproduction of clinical PSVT by programmed electrical stimulation, which is not uncommon in AV node reentrant tachycardia (AVNRT), is a dilemma in making the decision of the therapeutic end point of radiofrequency catheter ablation.

METHODS

Twenty-seven patients (group A) with documented but noninducible PSVT and with dual AV node pathways were prospectively studied. Programmed electrical stimulation could induce a single AV node echo beat in 12 patients, double echo beats in 4 patients and none in 11 patients at baseline or during isoproterenol infusion. Of the patients in group A, 16 underwent slow-pathway catheter ablation and 11 did not. The clinical and electrophysiologic characteristics of the 27 patients were compared with those of patients with dual AV node pathways and inducible AVNRT (group B, n = 55) and patients with dual AV node pathways alone without clinical PSVT (group C, n = 47).

RESULTS

During 23+/-13 months of follow-up, none of the 16 patients with slow-pathway catheter ablation had recurrence of PSVT. However, 7 of the 11 patients without ablation had PSVT recurrence at 13+/-14 months of follow-up (p < 0.03 by Kaplan-Meier analysis). Compared with groups B and C, group A consisted predominantly of men who had better retrograde AV node conduction and a narrower zone for anterograde slow-pathway conduction.

CONCLUSIONS

Slow-pathway catheter ablation is highly effective in eliminating spontaneous PSVT in which the tachycardia is not inducible despite the presence of dual AV node pathways.

摘要

目的

我们旨在研究慢径路导管消融术对有自发、记录在案的阵发性室上性心动过速（PSVT）且存在双房室（AV）结径路但无诱发性心动过速患者的长期疗效。

背景

在房室结折返性心动过速（AVNRT）中，程控电刺激不能诱发临床PSVT的情况并不少见，这给确定射频导管消融治疗终点带来了难题。

方法

对27例有记录但无诱发性PSVT且存在双AV结径路的患者（A组）进行前瞻性研究。在基线或静脉滴注异丙肾上腺素期间，程控电刺激能诱发出单个房室结回波搏动的患者有12例，诱发出双回波搏动的患者有4例，未诱发出回波搏动的患者有11例。A组患者中，16例接受了慢径路导管消融，11例未接受。将这27例患者的临床和电生理特征与有双AV结径路且有诱发性AVNRT的患者（B组，n = 55）以及仅有双AV结径路但无临床PSVT的患者（C组，n = 47）进行比较。