【作者】 张志权；

【导师】 李学文；

【作者基本信息】 山西医科大学 ， 心血管内科， 2010， 硕士

【摘要】 目的通过对不同基础频率心房起搏下测的房室结传导有效不应期的比较,评价不同基础频率心房起搏对房室结传导功能的影响。并对随着基础频率心房起搏的增加房室结呈递减性传导是频率滤过作用的基础等生理现象做出解释。不同频率心房起搏也可揭露房室结在某一频率下不能呈现的电生理现象。探讨经程序刺激S1S2扫描法在诱发室上性心动过速的价值。方法对60例室上性心动过速患者行心脏电生理检查及射频消融。测试不同基础频率心房起搏下房室结传导有效不应期。刺激方式采用心房程序刺激即8个S1S1脉冲后发放S2脉冲,分别给予S1S2600/400ms、S1S2500/400ms、S1S2400/400ms起搏,S1S2间期从400ms开始以1Oms递减。刺激选择冠状窦9、10。记录不同基础频率起搏下心房的有效不应期,房室结的功能不应期和有效不应期。诱发心动过速采用(1)S1S1法：此刺激包括短阵快速刺激,分级递增刺激等。(2)心房程序刺激法：程序刺激S2扫描法。(3)心室程序刺激：心房电刺激无效时,给于心室刺激。如果上述方法未能诱发心动过速,给予阿托品或异丙肾上腺素静脉滴注诱发心动过速。分别记录S1S1刺激法及程序刺激S1S2扫描法诱发室上性心动过速例数。对所采集的数据采用SPSS 13.0软件统计包进行数据处理,计量资料的测值以均数±标准差表示,多组间比较用单因素方差分析,两组间比较用t检验,计数资料用x2检验,两者相关性用非参数spearman等级相关分析,p<0.05为差异有统计学意义。结果本组60例患者中40例获得全部三种基础频率下的心房的有效不应期资料,结果显示随心房基础频率的逐渐增加,心房有效不应期相应缩短(P<0.05)。22例患者中获得全部三种基础频率下的房室结有效不应期的资料,随心房基础频率增加,房室结有效不应期延长(p<0.05),房室结功能不应期缩短(p<0.05)。本课题程序刺激S1S2扫描诱发房室折返性心动过速的成功率为95.0096,而S1S1起搏法诱发成功率只有66.67%。结论心房起搏频率的改变可影响房室结的有效不应期和传导功能。随心房基础频率增加,房室结有效不应期延长(p<0.05),房室结功能不应期缩短(p<0.05),这一效果和交感神经兴奋的改变对房室结传导功能的影响不同。了解起搏频率变化对房室结不应期的影响,对判断和分析心律失常的电生理特征具有重要意义。程序刺激S1S2更易插入两条路径的匹配间期使各自的传导延缓和不应期匹配,产生持续的、循环的电活动。因此适时的S2期前刺比快速起搏更能有效地诱发心动过速。程序刺激S2起搏法在诱发室上性心动过速中应作为首选。而影响旁路、房室结、房室结快慢径不应期匹配关系的因素,如调整基础起搏周期、用阿托品、异丙肾上腺素等药物均能增加室上性心动过速的诱发。更多还原

【Abstract】 Objective Atrial pacing with different fundamental frequency measured at the atrioventricular nodal effective refractory period compared to evaluate the fundamental frequency of different atrial pacing on AV node conduction function. With the foundation and increase the frequency of atrial pacing was reduced atrioventricular node conduction is based on the frequency filtering effect of other physiological phenomena to explain. Atrial pacing at different frequencies can reveal atrioventricular node can not be present at a frequency of electrophysiological phenomena. Stimulated by the process of scanning S1S2 induced supraventricular tachycardia in value.Method 60 patients with supraventricular tachycardia in patients with cardiac electrophysiology examination and radiofrequency ablation, stimulation with atrial pacing pulse is issued after 8 S1S1 S2 pulse. Were given S1S2600/400ms, S1S2500/400ms, S1S2400/400ms pacing, S1S2 interval beginning from 400 ms to 10 ms reduced. Coronary sinus to stimulate the choice 9,10. Recorded under different pacing based on the frequency of atrial effective refractory period, atrioventricular node functional refractory period and effective refractory period, dual atrioventricular node pathways fast pathway and slow pathway effective refractory period. Tachycardia induced by (1) S1S1 method:This includes a short array to stimulate the rapid stimulation Gradually stimulating and so on. (2) atrial stimulation programs:Program to stimulate the S2 scanning. (3) ventricular programmed stimulation:atrial electrical stimulation fails to stimulate in the ventricle. If the above are not sufficient to induce tachycardia, given intravenous isoproterenol or atropine-induced tachycardia. The data were collected on SPSS13.0 software statistical package for data processing, measurement data of measured values mean±standard deviation between the two groups compared by t test among groups using ANOVA, with count dataχ2 test, correlation between the use of non-parametric spearman rank correlation analysis, (P<0.05)as statistically significant difference.Results 60 patients,40 patients were all three basic frequency of atrial effective refractory period data showed that blossoms gradually increase the frequency of house foundation, atrial effective refractory period shortened accordingly (P<0.05).22 patients received all three basic frequency of the atrioventricular node effective refractory period of the data. Xpress room base rate will increase, atrioventricular node effective refractory period extension (P＜0.05), atrioventricular nodal functional refractory period shortened (P<0.05). The subject program to stimulate the S1S2 pacing-induced atrioventricular reentrant tachycardia method success rate 97.18%, while the S1S1 pacing success rate of inducing only 67,61%. P= 0.001,The difference was statistically significant.Conclusion The atrial pacing rate of change can affect the AV node effective refractory period and conduction in refractory period. Xpress room base rate will increase, atrioventricular node effective refractory period extension (P<0.05), atrioventricular nodal functional refractory period shortened(P<0.05). The role of changes in sympathetic tone different. Read pacing frequency on the atrioventricular node Refractory period of analysis and assessment of physiological characteristics of arrhythmia is very important point. Reentrant tachycardia caused by the two paths should be the greater of the margin, the more wide-induced tachycardia in the window, the program to stimulate the S2 insert more matches between the two paths to each of the transmission delay and should not be on the match to create a continuous, electrical activity cycle. Therefore timely S2 ago thorn more effective than the rapid pacing-induced tachycardia. Therefore affect the bypass, atrioventricular node, atrioventricular node speed track should match the relationship of the factorsPacing cycle as the basis for adjustment, with atropine, isoproterenol and other drugs can increase atrioventricular reentrant tachycardia induced.更多还原