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目的探讨隐匿性间隔旁道的诊断及射频消融方法的临床价值。方法对 41例心动过速时心房激动顺序呈向心性分布且无房室传导跳跃者分别进行不同刺激 :①心动过速时希氏束不应期内分别于右室心尖部及心底部RS2 刺激 ;②右室心底部和心尖部的S1S1递增刺激 ,比较VA差值 ;③右室起搏下静注ATP ,用以上 3种方法诊断为隐匿性间隔旁道后 ,分别于右室起搏下放电消融和在心动过速或心房起搏下放电消融。结果 2 8例隐匿性间隔旁道 ,13例不典型房室结折返性心动过速 (AVNRT)。希氏束不应期内RS2 刺激心底部对诊断隐匿性间隔旁道的临床准确性为 90 .2 % ,刺激心尖部为 82 .9% ,S1S1刺激心底部和心尖部的VA差值的临床准确性为 78.2 % ,静注ATP的临床准确性为 63 .4%。右室起搏放电消融 12例 ,有 3例发生一过性房室传导阻滞 ;16例在心动过速和心房起搏下放电消融未发生房室传导阻滞。结论隐匿性间隔旁道与不典型AVNRT的鉴别 ,以心动过速时希氏束不应期内RS2 刺激右室心底部临床准确性最高 ,S1S1刺激心底部与心尖部的VA差值对进行二者的鉴别意义也较大 ,静注ATP可靠性差。在心动过速及心房起搏下射频消融隐匿性间隔旁道较安全 ,不易引起房室传导阻滞
Objective To investigate the clinical value of diagnosis and radiofrequency ablation of concealed interval bypass. Methods 41 cases of atrial tachycardia were atrial concen- tration with concentric distribution and without atrioventricular conduction jerk, respectively, with different stimuli: ① tachycardia intrathoracic refractory period were right ventricular apical and basal RS2 stimulation ; ② Right ventricular heart and apical S1S1 incremental stimulation, comparison of VA difference; ③ right ventricular pacing intravenous ATP, the above three methods are diagnosed as occult bypass, respectively, right ventricular pacing Discharge ablation and ablation under tachycardia or atrial pacing. Results There were 28 cases of concealed septal bypass and 13 cases of atypical atrioventricular nodal reentrant tachycardia (AVNRT). The clinical accuracy of RS2-stimulated bottom of the heart during the His bundle-beam period was 90.2% for diagnosis of occult paracancer, 82.9% for apical stimulation, The accuracy was 78.2%, and the clinical accuracy of intravenous ATP was 63.4%. Right ventricular pacing and discharge ablation in 12 cases, 3 cases of a transient atrioventricular block; 16 cases of atrial tachycardia and atrial pacing underwent ablation without atrioventricular block. Conclusions The identification of AVNRT between occult septum and atypical AVNRT has the highest clinical accuracy at the bottom of right ventricular myocardium with RS2 stimulation during Hiszheimer’s period and the difference of VA between S1S1 stimulation and apical part The significance of those who identify larger, intravenous ATP poor reliability. In tachycardia and atrial pacing underwent radiofrequency occult occult parallels, safer, less likely to cause atrioventricular block