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目的:评价射频消融慢径治疗程控不能诱发且没有跳跃的房室结折返性心动过速(AVNRT)患者的远期疗效,探讨其电生理机制。方法:临床证实的AVNRT患者101例,在电生理检查中18例程控不能诱发及没有跳跃(A组),19例程控不能诱发(B组),33例程控没有跳跃(C组),31例程控有跳跃并且能诱发(D组)。比较各组电生理的情况及射频消融治疗的远期疗效。结果:术后随访(49.13±30.13)个月,C组1例于术后2个月复发,发生Ⅲ度房室传导阻滞而安装起搏器,D组1例于手术后7个月复发,A、B、C、D组的未复发率均差异无统计学意义(P>0.05)。A、B组与C、D组相比快径逆传功能相对较差,术前B组的快慢径不应期差值较D组小,各组有效消融后交界心律的发生率差异无统计学意义。结论:慢径消融在治疗程控不能诱发及没有跳跃的AVNRT患者是安全有效的。交界性心律可以作为该类患者的射频消融的参考终点。
OBJECTIVE: To evaluate the long-term efficacy of radiofrequency ablation of slow pathway in the treatment of patients with atrioventricular nodal reentrant tachycardia (AVNRT) that can not be induced and without jumping, and to explore its electrophysiological mechanism. Methods: A total of 101 patients with clinically proven AVNRT were enrolled in this study. Echocardiography was performed in 18 patients with program-induced or non-skip control (group A) Program-controlled jumping and can induce (D group). The electrophysiological status of each group and the long-term effect of radiofrequency ablation were compared. Results: The follow-up was (49.13 ± 30.13) months. One patient in group C recurred at 2 months after operation. The third-degree atrioventricular block occurred and pacemaker was installed. One patient in group D recurred 7 months after operation There was no significant difference in the recurrence rates between groups A, B, C and D (P> 0.05). Compared with group C and group D, group A and group B had relatively poor fast-acting and retrograde function, and the differences of fast-track and slow-course refractory period in group B before operation were smaller than those in group D. There was no statistical difference in the incidence of border rhythm after effective ablation Significance of learning. Conclusion: Slow-pathway ablation is safe and effective in the treatment of patients with AVNRT which can not be induced by program-controlled or without jump. Borderline rhythm can be used as a reference endpoint for radiofrequency ablation in this group of patients.