背景:导管消融术是治疗阵发性室上性心动过速(SVT)的方法。然而,房性心动过速(AT)的诊断通常具有挑战性,特别是当SVT通过起搏终止时。
目的:本研究试图开发一种新的AT诊断方法。
方法:总共147个SVT,包括28个ATS,87例房室结折返性心动过速,前瞻性研究了32例正行性往复式心动过速。从比心动过速周期短20毫秒的耦合间隔开始,在近端冠状窦处进行单心房外刺激,并逐渐减少,直到首次重置希氏束(HB)为止,直到终止SVT为止。检查了第一次HB重置期间的SVT响应和终止模式。
结果:在28个ATs中的27个中,当HB复位时,心动过速不受影响,房室结折返性心动过速或直行性往复性心动过速(非AT),当HB复位时,心动过速同时复位或因心房-Hisian传导阻滞而终止。当心动过速持续的病例的耦合间隔进一步缩短时,所有33例室上性心动过速终止伴心房-Hisian传导阻滞的室上性心动过速均为非房性心动过速,而Hisian房传导阻滞终止了5例ATs和7例非ATs。敏感性,特异性,并且当Hb重置AT诊断时不受影响的心动过速模式的阳性和阴性预测值为96%,100%,100%,99%,分别。用于非AT诊断的心房Hisian阻滞终止心动过速的模式为92%,100%,100%,42%,分别。
结论:心动过速时近端冠状窦单心房刺激对AT诊断有用且有效。
BACKGROUND: Catheter ablation is the curative treatment for paroxysmal supraventricular tachycardia (SVT). However, atrial tachycardia (AT) diagnosis is often challenging, especially when SVT is terminated by pacing.
OBJECTIVE: This study sought to develop a novel method for AT diagnosis.
METHODS: A total of 147 SVTs including 28 ATs, 87 atrioventricular nodal re-entrant tachycardias, and 32 orthodromic reciprocating tachycardias were prospectively studied. Single atrial extrastimulation was performed at the proximal coronary sinus from a coupling interval 20 milliseconds shorter than the tachycardia cycle length and gradually decreased until the His bundle (HB) was first reset and further until the SVT was terminated. The response of the SVT during the first HB resetting and the termination pattern were examined.
RESULTS: In 27 of 28 ATs, tachycardia was unaffected when HB resetting whereas, in atrioventricular nodal re-entrant tachycardias or orthodromic reciprocating tachycardias (non-AT), tachycardia was simultaneously reset when HB resetting or was terminated with an atrio-Hisian block. When the coupling interval was further shortened for cases in which tachycardia persisted, all 33 SVTs with tachycardia termination with atrio-Hisian block were non-ATs, whereas 5 ATs and 7 non-ATs were terminated with Hisian-atrial block. The sensitivity, specificity, and positive and negative predictive values of the pattern of tachycardia that was unaffected when HB resetting for AT diagnosis were 96%, 100%, 100%, and 99%, respectively. Those of the pattern of tachycardia termination with atrio-Hisian block for non-AT diagnosis were 92%, 100%, 100%, and 42%, respectively.
CONCLUSIONS: Single atrial extrastimulation from the proximal coronary sinus during tachycardia was useful and effective for AT diagnosis.