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目的 探讨三磷酸腺苷 (adenosine triphosphate,ATP)对房室结双径路参与的房室交界区折返性心动过速和旁路参与的房室折返性心动过速患者的室房传导的电生理作用。 方法 39例房室交界区折返性心动过速和 6 7例房室折返性心动过速患者在右心室起搏 (频率 140次 / m in)时 ,经股静脉快速注射 ATP 2 0 mg,连续记录体表心电图和心内电图 ,观察室房传导变化。 结果 房室交界区折返性心动过速组 33例 (84.6 % )在注射 ATP后出现室房阻滞 ,其余 6例无变化。6 7例房室旁路患者在消融前 ,6 1例 (91% )室房传导无变化 ,另 6例出现室房阻滞 ,其中 2例具递减性传导 ;而在消融后 2 4例右心室起搏频率超过 16 0次 / m in,仍为 1∶ 1逆传 ,注射 ATP后 2 3例出现室房阻滞 ,仅 1例不受影响。 结论 ATP对房室结及旁路的电生理作用不同 ,注射 ATP后出现室房阻滞对鉴别经房室结或旁路逆传有一定价值 ,是旁路消融成功的一个判别指标 ,但并不一定完全可靠
Objective To investigate the electrophysiological effects of adenosine triphosphate (ATP) on ventricular conduction in patients with atrioventricular nodal reentrant tachycardia and by-pass atrioventricular reentrant tachyarrhythmias. Methods 39 cases of atrioventricular junction reentrant tachycardia and 67 cases of atrioventricular reentrant tachycardia in right ventricular pacing (frequency of 140 times / min), the rapid intravenous injection of 20 mg of ATP via the femoral vein, continuous Record surface ECG and ECG, observe changes in the conduction of the room. Results In the atrioventricular junctional reentrant tachycardia group, 33 cases (84.6%) had atrial fibrillation after injection of ATP, and the other 6 cases did not change. Sixty-seven patients with atrioventricular bypass had no change in the conduction of the ventricle before radiofrequency ablation, and the other six had ventricular blockade, of which two had degenerative conduction; and 24 Ventricular pacing frequency more than 160 times / m in, is still 1: 1 reverse transmission, 23 cases after injection of ATP appeared ventricular block, only 1 case is not affected. Conclusions The electrophysiological effects of ATP on atrioventricular node and shunt are different. Atrial fibrillation after ATP injection has some value in distinguishing transseptal or bypass retrograde. It is a discriminant index of success of bypass ablation. Not necessarily completely reliable