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目的比较不典型房室结折返性心动过速(atrioventricular nodal reentrant tachycardia,AVNRT)与典型AVNRT在消融时交界性心律伴有室房传导阻滞发生率、消融成功率和复发率等方面有无差异,探讨不典型AVNRT射频消融的疗效。方法 21例AVNRT患者电生理检查结果为不典型AVNRT组(慢慢型14例,快慢型7例),选择同期检查年龄和性别与不典型AVNRT组相匹配的典型AVNRT21例作为对照。2组患者均采用消融慢径的方法 ,以消融过程中出现交界性心律,消融后室上速不再被诱发作为消融成功终点。比较2组患者交界性心律伴有室房传导阻滞发生率、手术时间、X线曝光时间、消融次数、成功率、并发症发生率和复发率有无差异。结果 2组患者术中诱发的室上性心动过速周长无差异(P>0.05);与典型AVNRT组相比,不典型AVNRT组室上速时H-A间期延长[(155.90±40.86)msvs(32.62±18.25)ms,P=0.01],A-H间期缩短[(142.76±78.46)msvs(265.29±43.67)ms,P=0.034]。所有患者达消融成功终点。2组患者的手术时间、X线曝光时间、消融次数、并发症发生率无差异(P>0.05)。典型和非典型AVNRT患者慢径消融过程中均出现交界性心率反应,不典型AVNRT组交界性心律伴有室房传导阻滞发生率显著高于典型AVNRT组(66.7%vs9.5%,P=0.02),但无继发的房室传导阻滞发生。2组患者消融术后均无房室传导阻滞等并发症发生。随访(25.3±11.6)个月,不典型AVNRT组阵发性室上速的复发率高于典型AVNRT组(23.81%vs4.76%,P<0.05)。结论不典型AVNRT慢径消融安全有效。与典型AVNRT慢径消融相比,不典型AVNRT有效消融时,常出现交界性心律伴室房传导阻滞发生,但不提示房室传导阻滞。不典型AVNRT消融术后复发率相对较高。
Objective To compare the incidences of borderline arrhythmia, ablation success rate and recurrence rate between atypical atrioventricular nodal reentrant tachycardia (AVNRT) and typical AVNRT during ablation , To explore the atypical AVNRT radiofrequency ablation efficacy. Methods Twenty-one patients with AVNRT underwent electrophysiological examination of atypical AVNRT group (14 in chronic type and 7 in fast type), and selected 21 AVNRT patients of the same AVNRT group as the control group. Both groups adopted the method of ablation of slow pathway, and the borderline arrhythmia occurred during the ablation. After ablation, supraventricular tachycardia was no longer induced as the successful termination of ablation. The incidence of junctional blockage, operative time, X-ray exposure time, ablation frequency, success rate, complication rate and recurrence rate were compared between the two groups. Results There was no difference in the perioperative tachycardia-induced tachycardia between the two groups (P> 0.05). Compared with the typical AVNRT group, the HA interval in the untreated AVNRT group was longer than that in the AVNRT group [(155.90 ± 40.86) msvs (32.62 ± 18.25) ms, P = 0.01], shortening of AH interval [(142.76 ± 78.46) msvs (265.29 ± 43.67) ms, P = 0.034]. All patients reached the end of ablation success. The operation time, X-ray exposure time, the number of ablation and the incidence of complications in the two groups had no difference (P> 0.05). The borderline heart rate response was observed in both slow and slow ablation of typical and atypical AVNRT patients. The incidence of borderline ventricular tachycardia with ventricular block in atypical AVNRT group was significantly higher than that of the typical AVNRT group (66.7% vs 9.5%, P = 0.02), but no secondary atrioventricular block occurred. No complications such as atrioventricular block were found in the two groups after ablation. The recurrence rate of paroxysmal supraventricular tachycardia in the atypical AVNRT group was higher than that in the typical AVNRT group (23.81% vs 4.76%, P <0.05) at follow-up (25.3 ± 11.6) months. Conclusion Atypical AVNRT slow-path ablation is safe and effective. Compared with the typical AVNRT slow-pathway ablation, borderline ventricular arrhythmia often occurs in patients with atypical AVNRT ablation, but does not suggest atrioventricular block. The recurrence rate after atypical AVNRT ablation is relatively high.