中华心律失常学杂志
中華心律失常學雜誌
중화심률실상학잡지
CHINESE JOURNAL OF CARDIAC ARRHYTHMIAS
2010年
3期
204-207
,共4页
尹晓盟%张树龙%高连君%杨东辉%夏云龙%常栋%丛培鑫%王尹曼%魏显敬%林治湖%杨延宗
尹曉盟%張樹龍%高連君%楊東輝%夏雲龍%常棟%叢培鑫%王尹曼%魏顯敬%林治湖%楊延宗
윤효맹%장수룡%고련군%양동휘%하운룡%상동%총배흠%왕윤만%위현경%림치호%양연종
心房%房室结慢径区%消融
心房%房室結慢徑區%消融
심방%방실결만경구%소융
Atria%Atrioventricular node slow pathway%Ablation
目的 慢径消融降低了心房颤动(房颤)的易感性,但具体机制不明.本文旨在探讨消融后心房电生理性质的改变及其具体机制.方法 32例房室结折返性心动过速患者,测量射频消融前后窦性心率及高位右心房、低位右心房、冠状静脉窦近端和远端各部位的有效不应期和易感窗口,以及房室结快径前传不应期的变化.结果 (1)慢径消融前后下列部位的有效不应期的变化分别为:冠状静脉窦近端(21 8.1±21.8)ms,(235.3±23.6)ms,P＜0.0001;冠状静脉窦远端(230.9±21.0)ms,(244.7±25.1)ms,P＜0.01;低位右心房(198.8±26.7)ms,(219.7±28.7)ms,P＜0.005;高位右心房(214.4±35.1)ms,(213.4±37.3)ms,P=0.6.(2)在消融术后,房颤的诱发比例下降,冠状静脉窦近端的易感窗口显著降低(P=0.03),冠状静脉窦远端和低位右心房的易感窗口有所降低,高位右心房的易感窗口不变,但差异无统计学意义.(3)消融后窦性心率有一定程度的上升(72.1±5.6)次/min对(74±6.8)次/min,但差异无统计学意义(P=0.17).(4)慢径消融使快径前传不应期缩短,消融前后分别为(391±55)ms,(369±78)ms,P＜0.01.结论 慢径消融使心房多部位的电生理性质发生了改变,导致冠状静脉窦近端和远端,以及低位右心房的有效不应期延长,房颤诱发几率降低.该现象的原因可能与消融造成的迷走神经功能改变有关.
目的 慢徑消融降低瞭心房顫動(房顫)的易感性,但具體機製不明.本文旨在探討消融後心房電生理性質的改變及其具體機製.方法 32例房室結摺返性心動過速患者,測量射頻消融前後竇性心率及高位右心房、低位右心房、冠狀靜脈竇近耑和遠耑各部位的有效不應期和易感窗口,以及房室結快徑前傳不應期的變化.結果 (1)慢徑消融前後下列部位的有效不應期的變化分彆為:冠狀靜脈竇近耑(21 8.1±21.8)ms,(235.3±23.6)ms,P＜0.0001;冠狀靜脈竇遠耑(230.9±21.0)ms,(244.7±25.1)ms,P＜0.01;低位右心房(198.8±26.7)ms,(219.7±28.7)ms,P＜0.005;高位右心房(214.4±35.1)ms,(213.4±37.3)ms,P=0.6.(2)在消融術後,房顫的誘髮比例下降,冠狀靜脈竇近耑的易感窗口顯著降低(P=0.03),冠狀靜脈竇遠耑和低位右心房的易感窗口有所降低,高位右心房的易感窗口不變,但差異無統計學意義.(3)消融後竇性心率有一定程度的上升(72.1±5.6)次/min對(74±6.8)次/min,但差異無統計學意義(P=0.17).(4)慢徑消融使快徑前傳不應期縮短,消融前後分彆為(391±55)ms,(369±78)ms,P＜0.01.結論 慢徑消融使心房多部位的電生理性質髮生瞭改變,導緻冠狀靜脈竇近耑和遠耑,以及低位右心房的有效不應期延長,房顫誘髮幾率降低.該現象的原因可能與消融造成的迷走神經功能改變有關.
목적 만경소융강저료심방전동(방전)적역감성,단구체궤제불명.본문지재탐토소융후심방전생이성질적개변급기구체궤제.방법 32례방실결절반성심동과속환자,측량사빈소융전후두성심솔급고위우심방、저위우심방、관상정맥두근단화원단각부위적유효불응기화역감창구,이급방실결쾌경전전불응기적변화.결과 (1)만경소융전후하렬부위적유효불응기적변화분별위:관상정맥두근단(21 8.1±21.8)ms,(235.3±23.6)ms,P＜0.0001;관상정맥두원단(230.9±21.0)ms,(244.7±25.1)ms,P＜0.01;저위우심방(198.8±26.7)ms,(219.7±28.7)ms,P＜0.005;고위우심방(214.4±35.1)ms,(213.4±37.3)ms,P=0.6.(2)재소융술후,방전적유발비례하강,관상정맥두근단적역감창구현저강저(P=0.03),관상정맥두원단화저위우심방적역감창구유소강저,고위우심방적역감창구불변,단차이무통계학의의.(3)소융후두성심솔유일정정도적상승(72.1±5.6)차/min대(74±6.8)차/min,단차이무통계학의의(P=0.17).(4)만경소융사쾌경전전불응기축단,소융전후분별위(391±55)ms,(369±78)ms,P＜0.01.결론 만경소융사심방다부위적전생이성질발생료개변,도치관상정맥두근단화원단,이급저위우심방적유효불응기연장,방전유발궤솔강저.해현상적원인가능여소융조성적미주신경공능개변유관.
Objective The ablation of the atrioventricular node slow pathway may reduce the inducibility of atrial fibrillation (AF) ,but the mechanisms remain unknown. We tried to investigate the impact of ablation on atria refractory period, and to elucidate the underlying mechanism. Methods Thirty-two patients with atrioventricular node reentrant tachycardia (AVNRT) were enrolled in the study. Atria effective refractory period (ERP) and vulnerable window (VW) at high right atrium (HRA),inferior right atrium (IRA),distal (CSd) and proximal CS (CSp) ,as well as sinus rate (SR) and effective refractory period of fast pathway (FERP) were measured before and after ablation. Results ( 1 ) After ablation, the ERP at HRA did not change:(214. 4 ± 35. 1 ) ms, (213.4 ± 37. 3) ms, P = 0. 6, on the other hand, the ERPs at following sites were significantly prolonged:CSp(218. 1 ±21.8)ms, (235.3 ± 23.6) ms,P ＜0. 0001 ;CSd(230. 9 ±21.0) ms, (244. 7 ±25. 1)ms,P＜0. 01;IRA(198.8 ±26.7)ms,(219.7 ±28. 7) ms,P ＜ 0.005,respectively. (2) The VW of HRA remained unchanged after ablation, while the VWs of CSp, CSd and IRA trended to decline despite no statistic significant. (3)SR showed a little increasing but without statistic significant after ablation (P = 0. 17 ).(4) ERP of fast pathway was significantly decreased after ablation: ( 391 ± 55 ) ms, ( 369 ± 78 ) ms, P ＜ 0. 01.Conclusions The decrease of ERPs at CS and IRA, as well as F-ERP after ablation may decline the inducibility of atrial fibrillation and indicates regional vagal denervation to the atrium.
