食管心房调搏术终止阵发性室上性心动过速的疗效及安全性分析

摘要

目的:总结分析我院238例阵发性室上性心动过速行食管心房调搏术治疗的疗效及安全性.方法:使用心脏多功能刺激仪,采用亚速刺激法(低于室上性心动过速心率10~30次/min)→超速抑制法(高于室上性心动过速心率30~50次/min)→猝发脉冲法(快于室上性心动过速心率40%),按次序进行转复阵发性室上性心动过速.同时观察转复瞬间心电图表现,同步记录心电图至少至室上性心动过速终止后10 s,转为房颤者继续观察直至恢复窦性节律.结果:使用亚速刺激法238例,成功转复32例,成功率为13.4%;使用超速抑制法206例,成功转复173例,成功率为83.9%;使用猝发脉冲法28例,成功转复21例,成功率为75.0%;总有效率为95.0%(226/238).室上性心动过速终止瞬间心电图表现为:正常185例(77.7%)、P-R间期延长5例(2.1%)、房颤8例(3.4%)、交界性逸搏2例(0.8%)、长间歇>1 500 ms 5例(2.1%)、单发室性期前收缩5例(2.1%)、成对室性期前收缩6例(2.5%)、短阵室性心动过速5例(2.1%),除1例长间歇为3.2 s者予以72次/min频率的心房起搏外,余病例未予特殊处理.结论:食管心房调搏术终止阵发性室上性心动过速安全高效,可作为治疗折返性心动过速的首选方法.%Objective: To summarize and analyze the efficacy and safety in 238 patients with paroxysmal supraventricular tachycardia (PSVT) by transesophageal atrial pacing (TEAP). Methods: Heart multifuctionnal pacing stimulator, together with underdrive pacing (10-30 bpm lower than the rate of PSVT )→overdrive pacing (30-50 bpm higher than the rate of PSVT ) → sudden pacing (40% higher than the rate of PSVT) were used to terminate PSVT by turn. At the same time all the instant electrocardiograms(ECG) were observed at least 10 seconds after the end of PSVT. If atrial fibrillation appeared, these cases were kept on observing till transformation. Results: Among 238 cases who were given underdrive pacing, 32 cases were successful, the successful rate was 13.4%; 206 cases were given overdrive pacing and 173 cases were successful, the successful rate was 83.9%; 28 cases were given sudden pacing and 21 cases were successful, the successful rate was 75.0%, the total effective rate was 95.0%(226/238).OF all the instant ECG after the end of PSVT, there were 185 cases of normality(77.7%), 5 cases of long P-R interval(2.1%), 8 cases of atrial fibrillation(3.4%), 2 cases of junctional escape beat(0.8%), 5 cases of long pause over 1 500 seconds(2.1%), 5 cases of single ventricular premature beat(2.1%), 6 cases of ventricular premature beat couplets(2.5%) and 5 cases of transient ventricular tachycardia(2.1%). No patient had been given special treatment except that one had been given atrial pacing of 72 bpm, who had a long pause of 3.2 seconds. Conclusion: It is safe and effective to terminate PSVT by TEAP, which can be the preferred method for reentrant tachycardia.