慢径消融后快径前传及逆传功能变化的研究
发布时间：2019-01-26 08:24
【摘要】：目的：本研究旨在在前人研究的基础上,通过严格控制研究条件,创新观察指标,增加对AVNRT患者慢径消融后逆传功能的研究角度,探讨慢快型房室结折返性心动过速(SF-AVNRT)患者慢径消融后快径传导功能的变化,进而通过观察慢径消融后快径传导功能的变化来推测房室结快径及慢径之间的关系,为日后房室结确切结构的进一步研究提供可靠的电生理方面的依据。方法：对2013年11月至2014年8月112例因发作性心悸在我科住院的患者进行心腔内电生理检查,其中48例电生理检查确诊为有明显跳跃现象的SF-AVNRT。对这48例患者电极重新放置至标准位置,然后行高位右房(HRA)刺激S1S1 500ms刺激,测定Hisl、2级AH间距,即房室结的传导时间,行S1S2刺激记录房室结的跳跃点以及测量跳跃值,以该跳跃点为AVNRT患者术前快径的有效不应期(ERP前)。行RV S1S1 500ms刺激测定His1、2极HA间距作为房室结的逆传时间,行S1S2刺激记录房室结逆传跳跃点以及测定房室结逆传有效不应期(ERP逆)不应期。然后对患者性慢径射频消融术,常规采用下位法消融,以出现慢结性心律为有效,以HRA S1S2刺激无AH跳跃,无房室结折返为手术的终点。术后再将电极送至术前的标准位置,行HRA S1S1 500ms刺激测定房室结的传导时间(TFP前),行S1S2刺激测定房室结的有效不应期(ERPFP前),此时房室结的不应期即为快径的有效不应期,行RV S1S1500ms刺激测定房室结的逆传时间,行S1S2刺激测定房室结逆传的有效不应期(ERPFP前),比较术前术后快径的传导时间、有效不应期是否有变化,然后根据研究结果推测房室结快慢径之间的关系。结果：1、入选的48例患者均手术成功,均未出现并发症,术后重复心内电生理检查均无明显AH跳跃,亦未诱发任何心动过速发作及房室结单个折返,达到慢径完全消融慢径的标准。2、入选的48例患者快径前向传导时间(TFP前)由术前的106.04-+36.36ms缩短为术后89.98-+27.09ms,p0.001,差异具有统计学意义；3、快径前向传导的有效不应期(ERPFP前)由术前330.00±53.31ms缩短为术后250.21-±56.81ms,P0.001,差异具有统计学意义；4、快径逆向传导时间(TFP逆)由术前的94.54+28.39ms缩短至术后86.62+24.88ms,P=-0.010,差异具有统计学意义。结论：房室结折返性心动过速患者慢径消融后快径前向及逆向传导功能均得到改善。慢径及快径并不是相互独立存在的结构,而是相互影响,相互联系的,慢径的存在抑制了快径的传导。
[Abstract]:Objective: the purpose of this study was to increase the research angle of retrograde transmission after slow pathway ablation in patients with AVNRT by strictly controlling the research conditions and innovating the observation indexes on the basis of previous studies. To investigate the changes of fast pathway conduction function after slow pathway ablation in patients with slow fast atrioventricular nodal reentrant tachycardia (SF-AVNRT), and to speculate the relationship between atrioventricular nodal fast pathway and slow pathway by observing the changes of fast path conduction function after slow pathway ablation. It provides reliable electrophysiological basis for further study on the exact structure of atrioventricular node. Methods: from November 2013 to August 2014, 112 patients with paroxysmal palpitation in our department were examined by endocardial electrophysiological examination, 48 of which were diagnosed as SF-AVNRT. with obvious jumping phenomenon. In the 48 patients, the electrode was placed to the standard position, and then the high right atrium (HRA) was used to stimulate S1S1 500ms stimulation. The Hisl,2 AH interval was measured, that is, the conduction time of atrioventricular node, the jumping point of atrioventricular node was recorded and the jumping value was measured by S1S2 stimulation. This jumping point was used as the effective refractory period (before ERP) for preoperative fast pathway in patients with AVNRT. RV S1S1 500ms stimulation was performed to determine the HA distance between the ends of the His1,2 pole as the retrograde time of atrioventricular node (AVN), and S1S2 stimulation was performed to record the atrioventricular nodal retrograde jump point and to determine the effective refractory period (ERP inverse) of atrioventricular nodal inversion (AVN). Then the patients with slow pathway radiofrequency ablation were routinely ablated by inferior method. The onset of slow nodal rhythm was effective. The end point of the operation was HRA S1S2 stimulation without AH jumping and atrioventricular nodal reentry. The electrode was sent to the standard position before operation. The conduction time of atrioventricular node was measured by HRA S1S1 500ms stimulation (before TFP), and the effective refractory period (before ERPFP) by S1S2 stimulation. The refractory period of atrioventricular node was the effective refractory period of fast pathway. The reverse-transit time of atrioventricular node was measured by RV S1S1500ms stimulation, and the effective refractory period (before ERPFP) was measured by S1S2 stimulation. The conduction time of fast pathway before and after operation was compared, and whether the effective refractory period changed or not. The relationship between the fast and slow pathway of atrioventricular node was inferred based on the results of the study. Results: 1. All the 48 patients were successfully operated without complications. No significant AH jump was found in repeated cardiac electrophysiological examination, nor any tachycardia or atrioventricular nodal reentry was induced. To reach the standard of complete slow pathway ablation, 48 patients were enrolled in the study. The fast path forward conduction time (TFP) was shortened from 106.04- 36.36ms to 89.98-27.09msp0.001. The difference was statistically significant. 3, the effective refractory period of fast path forward conduction (before ERPFP) was shortened from 330.00 卤53.31ms to 250.21- 卤56.81msP 0.001, the difference was statistically significant. 4, fast path reverse conduction time (TFP inverse) was shortened from 94.54 28.39ms to 86.62 24.88 Ms P0. 010 after operation. The difference was statistically significant. Conclusion: the fast pathway forward and reverse conduction function were improved after slow pathway ablation in patients with atrioventricular nodal reentrant tachycardia. Slow path and fast path are not independent structures, but interact with each other. The existence of slow path inhibits the conduction of fast path.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.7
本文编号：2415303
[Abstract]:Objective: the purpose of this study was to increase the research angle of retrograde transmission after slow pathway ablation in patients with AVNRT by strictly controlling the research conditions and innovating the observation indexes on the basis of previous studies. To investigate the changes of fast pathway conduction function after slow pathway ablation in patients with slow fast atrioventricular nodal reentrant tachycardia (SF-AVNRT), and to speculate the relationship between atrioventricular nodal fast pathway and slow pathway by observing the changes of fast path conduction function after slow pathway ablation. It provides reliable electrophysiological basis for further study on the exact structure of atrioventricular node. Methods: from November 2013 to August 2014, 112 patients with paroxysmal palpitation in our department were examined by endocardial electrophysiological examination, 48 of which were diagnosed as SF-AVNRT. with obvious jumping phenomenon. In the 48 patients, the electrode was placed to the standard position, and then the high right atrium (HRA) was used to stimulate S1S1 500ms stimulation. The Hisl,2 AH interval was measured, that is, the conduction time of atrioventricular node, the jumping point of atrioventricular node was recorded and the jumping value was measured by S1S2 stimulation. This jumping point was used as the effective refractory period (before ERP) for preoperative fast pathway in patients with AVNRT. RV S1S1 500ms stimulation was performed to determine the HA distance between the ends of the His1,2 pole as the retrograde time of atrioventricular node (AVN), and S1S2 stimulation was performed to record the atrioventricular nodal retrograde jump point and to determine the effective refractory period (ERP inverse) of atrioventricular nodal inversion (AVN). Then the patients with slow pathway radiofrequency ablation were routinely ablated by inferior method. The onset of slow nodal rhythm was effective. The end point of the operation was HRA S1S2 stimulation without AH jumping and atrioventricular nodal reentry. The electrode was sent to the standard position before operation. The conduction time of atrioventricular node was measured by HRA S1S1 500ms stimulation (before TFP), and the effective refractory period (before ERPFP) by S1S2 stimulation. The refractory period of atrioventricular node was the effective refractory period of fast pathway. The reverse-transit time of atrioventricular node was measured by RV S1S1500ms stimulation, and the effective refractory period (before ERPFP) was measured by S1S2 stimulation. The conduction time of fast pathway before and after operation was compared, and whether the effective refractory period changed or not. The relationship between the fast and slow pathway of atrioventricular node was inferred based on the results of the study. Results: 1. All the 48 patients were successfully operated without complications. No significant AH jump was found in repeated cardiac electrophysiological examination, nor any tachycardia or atrioventricular nodal reentry was induced. To reach the standard of complete slow pathway ablation, 48 patients were enrolled in the study. The fast path forward conduction time (TFP) was shortened from 106.04- 36.36ms to 89.98-27.09msp0.001. The difference was statistically significant. 3, the effective refractory period of fast path forward conduction (before ERPFP) was shortened from 330.00 卤53.31ms to 250.21- 卤56.81msP 0.001, the difference was statistically significant. 4, fast path reverse conduction time (TFP inverse) was shortened from 94.54 28.39ms to 86.62 24.88 Ms P0. 010 after operation. The difference was statistically significant. Conclusion: the fast pathway forward and reverse conduction function were improved after slow pathway ablation in patients with atrioventricular nodal reentrant tachycardia. Slow path and fast path are not independent structures, but interact with each other. The existence of slow path inhibits the conduction of fast path.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.7
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