从慢径消融发生的交界区心律试探房室结双径的本质

７６例慢－快型房室结折返性心动过速（ＡＶＮＲＴ）患者接受房室结慢径消融术。６５例慢径阻断、９例双径存在但ＡＶＮＲＴ不能诱发、２例快径阻断。慢径阻断后，除快径的前传有效不应期（ＥＲＰ）缩短（２８７．０±７９．０ｍｓｖｓ３４４．０±８７．０ｍｓ，Ｐ＜０．０１）外，房室传导的文氏点、２１阻滞点、室房传导的１１点、快径逆传ＥＲＰ、前传和逆传功能不应期均无明显改变。共放电８４１次，其中无交界区心律的３１７次放电，无一次消融成功。６５例慢径阻断者，交界区心律减少或消失。以上结果提示快径和慢径可能是两条各具电生理特性的传导纤维。

Study on Nature of Dual Atrioventricular Nodal Pathways From the Changes of Junctional Rhythm During Slow Pathway Radiofrequency Ablation

Slow atrioventricular nodal pathway (SP) ablation was performed in 76 patients with slow fast atrioventricular nodal reentrant tachycardia (AVNRT) using radiofrequency energy.AVNRT couldnt be induced in all patients after radiofrequency ablation.SPs were eliminated in 65 patients and the conduction time of SP was longer in 9 patients after ablation.Fast atrioventricular nodal pathway (FP) were eliminated in 2 cases.It was not found that changes of maximal pacing frequency that maintain AV nodal or VA 1∶1 conduction,AV conduction 2∶1 block point,antegrade and retrograde FP functional refractory period (FRP),retrograde FP effective refractory period (ERP) except that antegrade FP ERP was shorten ( P <0.01) in 65 patients that their SP have been ablated successfully.It suggested that SP and FP are different conduction fibers.No time was successful in 317 times radiofrequency ablation that did not take place junctional rhythm.Junctional rhythm numbers were decreased when SP was eliminated in 65 patients.We conclude that SP may not be a intrinsic atrioventricular node but another kind of tissue.