CAJ | 학술논문

目的：分析房室结折返性心动过速（AVNRT）患者行射频消融（RFCA）术前后房室传导功能的电生理参数变化，探讨不同消融终点对 AVNRT 患者房室传导功能的影响及疗效。方法96例 AVNRT 行RFCA 慢径患者，依据慢径是否消除分为慢径消失组和慢径改良组，分别记录患者 RFCA 术前、术后反映房室传导功能的腔内电生理检查数据：PA、AH、HV 间期，房室结前传文氏点（AVN-WKB），房室结快慢径路前传有效不应期（AVB-WKB），将术前术后的电生理参数进行比较分析，且电话随访患者1年，比较慢径消失组与慢径改良组术后心动过速复发情况。结果 RFCA 术对 AVNRT 患者房室结前传时间的影响：与 RFCA 术前比，术后希氏束电图 PA、AH、HV 间期均无明显变化（均 P ＞0．05）。RFCA 术对 AVNRT 患者房室结前传不应期的影响：与 RFCA 术前比较，慢径消失组术后快径有效不应期缩短[术前（287．5±46．2）ms，术后（260．2±55．6）ms，t ＝2．901，P ＝0．005]，慢径有效不应期消失[术前（243．3±43．2），术后（0．0±0．0）ms，t ＝43．290， P ＝0．000]，房室结前传文氏点提前[术前（261．3±44．3）ms，术后（293．2±46．2）ms，t ＝3．828，P ＝0．000]；慢径改良组术后快径有效不应期无明显变化（P ＞0．05），慢径有效不应期延长[术前（242．2±42．8）ms，术后（281．2±41．3）ms，t ＝3．879，P ＝0．000；），房室结前传文氏点提前[术前（261．5±43．5）ms，术后（291．3±46．5）ms，t ＝2．769，P ＝0．007）。组间比较，术后慢径消失组快径有效不应期明显短于慢径改良组，但两组间房室结前传文氏点差异无统计学意义（P ＞0．05）。随访1年后慢径消失组与慢径改良组均无复发病例。结论 RFCA 术致慢径消失或慢径改良两种消融终点对 AVNRT 患者房室传导时间均无影响，但均使房室结前传文氏点提前；慢径消失使房室结快径有效不应期缩短，慢径改良使慢径有效不应期延长。RFCA 术致慢径消失或慢径改良两种消融终点对 AVNRT 患者均疗效肯定，1年内均无复发率。目的：分析房室結摺返性心動過速（AVNRT）患者行射頻消融（RFCA）術前後房室傳導功能的電生理參數變化，探討不同消融終點對 AVNRT 患者房室傳導功能的影響及療效。方法96例 AVNRT 行RFCA 慢徑患者，依據慢徑是否消除分為慢徑消失組和慢徑改良組，分彆記錄患者 RFCA 術前、術後反映房室傳導功能的腔內電生理檢查數據：PA、AH、HV 間期，房室結前傳文氏點（AVN-WKB），房室結快慢徑路前傳有效不應期（AVB-WKB），將術前術後的電生理參數進行比較分析，且電話隨訪患者1年，比較慢徑消失組與慢徑改良組術後心動過速複髮情況。結果 RFCA 術對 AVNRT 患者房室結前傳時間的影響：與 RFCA 術前比，術後希氏束電圖 PA、AH、HV 間期均無明顯變化（均 P ＞0．05）。RFCA 術對 AVNRT 患者房室結前傳不應期的影響：與 RFCA 術前比較，慢徑消失組術後快徑有效不應期縮短[術前（287．5±46．2）ms，術後（260．2±55．6）ms，t ＝2．901，P ＝0．005]，慢徑有效不應期消失[術前（243．3±43．2），術後（0．0±0．0）ms，t ＝43．290， P ＝0．000]，房室結前傳文氏點提前[術前（261．3±44．3）ms，術後（293．2±46．2）ms，t ＝3．828，P ＝0．000]；慢徑改良組術後快徑有效不應期無明顯變化（P ＞0．05），慢徑有效不應期延長[術前（242．2±42．8）ms，術後（281．2±41．3）ms，t ＝3．879，P ＝0．000；），房室結前傳文氏點提前[術前（261．5±43．5）ms，術後（291．3±46．5）ms，t ＝2．769，P ＝0．007）。組間比較，術後慢徑消失組快徑有效不應期明顯短于慢徑改良組，但兩組間房室結前傳文氏點差異無統計學意義（P ＞0．05）。隨訪1年後慢徑消失組與慢徑改良組均無複髮病例。結論 RFCA 術緻慢徑消失或慢徑改良兩種消融終點對 AVNRT 患者房室傳導時間均無影響，但均使房室結前傳文氏點提前；慢徑消失使房室結快徑有效不應期縮短，慢徑改良使慢徑有效不應期延長。RFCA 術緻慢徑消失或慢徑改良兩種消融終點對 AVNRT 患者均療效肯定，1年內均無複髮率。
목적：분석방실결절반성심동과속（AVNRT）환자행사빈소융（RFCA）술전후방실전도공능적전생리삼수변화，탐토불동소융종점대 AVNRT 환자방실전도공능적영향급료효。방법96례 AVNRT 행RFCA 만경환자，의거만경시부소제분위만경소실조화만경개량조，분별기록환자 RFCA 술전、술후반영방실전도공능적강내전생리검사수거：PA、AH、HV 간기，방실결전전문씨점（AVN-WKB），방실결쾌만경로전전유효불응기（AVB-WKB），장술전술후적전생리삼수진행비교분석，차전화수방환자1년，비교만경소실조여만경개량조술후심동과속복발정황。결과 RFCA 술대 AVNRT 환자방실결전전시간적영향：여 RFCA 술전비，술후희씨속전도 PA、AH、HV 간기균무명현변화（균 P ＞0．05）。RFCA 술대 AVNRT 환자방실결전전불응기적영향：여 RFCA 술전비교，만경소실조술후쾌경유효불응기축단[술전（287．5±46．2）ms，술후（260．2±55．6）ms，t ＝2．901，P ＝0．005]，만경유효불응기소실[술전（243．3±43．2），술후（0．0±0．0）ms，t ＝43．290， P ＝0．000]，방실결전전문씨점제전[술전（261．3±44．3）ms，술후（293．2±46．2）ms，t ＝3．828，P ＝0．000]；만경개량조술후쾌경유효불응기무명현변화（P ＞0．05），만경유효불응기연장[술전（242．2±42．8）ms，술후（281．2±41．3）ms，t ＝3．879，P ＝0．000；），방실결전전문씨점제전[술전（261．5±43．5）ms，술후（291．3±46．5）ms，t ＝2．769，P ＝0．007）。조간비교，술후만경소실조쾌경유효불응기명현단우만경개량조，단량조간방실결전전문씨점차이무통계학의의（P ＞0．05）。수방1년후만경소실조여만경개량조균무복발병례。결론 RFCA 술치만경소실혹만경개량량충소융종점대 AVNRT 환자방실전도시간균무영향，단균사방실결전전문씨점제전；만경소실사방실결쾌경유효불응기축단，만경개량사만경유효불응기연장。RFCA 술치만경소실혹만경개량량충소융종점대 AVNRT 환자균료효긍정，1년내균무복발솔。
Objective The electrophysiological parameters of atrioventricular conduction function in patients with atrioventricular nodal reentry tachycardia (AVNRT)were analyzed,and to explore the effect of different ablation endpoints on atrioventricular conduction function in patients with AVNRT.Methods 96 cases with AVNRT under-went radiofrequency catheter ablation (RFCA)of slow conduction pathway.According to whether the slow pathway eliminated,the patients were divided into the slow pathway disappeared group and slow tracks remaining group.Preop-erative and postoperative intracavitary electrophysiological examination and atrioventricular function data were recor-ded,including before and after radiofrequency ablation of bundle of HIS,PA,AH,HV interval,atrioventricular prequel venturi point(AVN -WKB),ventriculoatrial retrograde venturi point(VAN -WKB),atrioventricular node prequel effective refractory period(AVB -WKB).Patients were followed up by telephone for a year.Then,a comparative anal-ysis of preoperative and postoperative was done.Results RFCA of AVNRT patients with atrioventricular node pre-quel time effect:RFCA and preoperative ratio,after his bundle electrogram PA,ah,HV interval had no significant changes(P >0.05).Effect of RFCA surgery on patients with AVNRT refractory atrioventricular node prequel:com-pared with RFCA before surgery,postoperative slow pathway disappear fast pathway shortening of effective refractory period[preoperative(287.5 ±46.2)ms,postoperative(260.2 ±55.6)ms,t =2.901,P =0.005],slow pathway effec-tive refractory period[disappear preoperative(243.3 ±43.2),postoperative(0.0 ±0.0)ms,t =43.290,P =0.000], AV node Wenckebach point in advance before operation[(261.3 ±44.3)ms,postoperative(293.2 ±46.2)ms,t =3.828,P =0.000];group after slow pathway to improve fast pathway effective refractory period without obvious change (P >0.05 ),the slow pathway effective refractory period in high concentration [preoperative (242.2 ± 42.8)ms,postoperative(281.2 ±41.3 )ms,t =3.879,P =0.000〗,atrioventricular node Wenckebach point in advance before operation[(261.5 ±43.5)ms,postoperative(291.3 ±46.5)ms,t =2.769,P =0.007〗.Comparison between groups,after slow pathway disappeared group fast pathway effective refractory period was significantly shorter in the slow diameter improvement group,but between the two groups in the atrioventricular node Wenckebach point differences was not statistically significant(P >0.05).There was no recurrence in the follow -up after a year of slow path loss and slow pathway.Conclusion RFCA caused by slow pathway to disappear or modified two slow pathway ablation right AVNRT patients atrioventricular time had no effect,but all the atrioventricular junction the prequel's point advance.The atrioventricular node slow pathway disappear fast and effective pathway refractory period short-ened,slow pathway improved the slow pathway effective refractory period.RFCA surgery done by the slow pathway dis-appeared or slow pathway ablation is effective in patients with AVNRT,and there was no significant recurrence rate in both groups within 1 year.