索他洛尔对房室旁道心脏电生理的影响(摘要)
作者：刘召红 廖德宁 赵学 张家友
单位：山东省烟台市，中国人民解放军第107医院 心内科(264002) 刘召红；上海市，中国人民解放军第二军医大学附属长征医院 心内科 廖德宁 赵 学 张家友
关键词：
目的 目的：观察索他洛尔对房室旁道患者心脏电生理的影响，对药物在射频导管消融术(RFCA)中的应用作初步探讨。
方法：18例房室折返性心动过速(AVRT)患者，男8例，女10例，平均年龄39.8(15～69)岁，左侧旁道14例(显性2例，隐匿性12例)，右侧旁道4例(显性2例，隐匿性2例)。Seldinger′s法经右侧颈内及股静脉分别插入冠状窦(CS)、高位右心房(HRA)、希氏束(HRE)及右心室心尖(RVA)导管电极。行常规心内电生理检查后顿服索他洛尔160 mg,于服药后30分、60分、90分、120分、150分重复测量各项电生理参数。
, http://www.100md.com
结果：服药后P-A、P-R、A-H、H-V、QRS间期无明显变化。8例出现窦性心动过缓，但无头晕、乏力、胸闷等不适。窦房结恢复时间(SNRT)1?165±209 ms比1?456±371 ms,窦性周长(SCL)724±116 ms比996±178 ms(P<0.05)。心房有效不应期(ERP)211±24 ms比243±36 ms,心室ERP 205±11 ms比242±28 ms,房室结前传ERP 269±48 ms比343±97 ms,旁道前传ERP 263±45 ms比400±160 ms,旁道逆传ERP 232±37 ms比289±50 ms(P均<0.05)。心动过速周长323±49 ms比382±25 ms,心动过速诱发带66±20 ms比30±17 ms(P<0.05)。诱发性心动过速自行终止率67%。100次/分心房起搏时QT间期339±31 ms比364±27 ms(P<0.05)。3例患者心房/心室电刺激易于诱发心房颤动在服用索他洛尔30分后心房颤动不再诱发。其中1例患者，首次RFCA因术中频发心房颤动而放弃手术，第2次给予索他洛尔160 mg口服，心房颤动不再发作，消融成功。2例心内电刺激难以终止的AVRT，在服药后40分心动过速自行终止于房室结前传，且不再诱发。18例患者均消融成功，随访10～18个月无一例复发。
, 百拇医药
结论：顿服索他洛尔160 mg，吸收好，见效快，可显著延长心脏有效不应期，且不阻断旁道。旁道射频导管消融术中应用可预防或终止电刺激诱发的心房颤动，有效抑制心动过速，提高患者的耐受性，同时不影响手术效果评价。
Electrophysiological Effects of Sotalol on Patients with Atrioventricular Accessory Pathways (Abstract)
Department of Cardiology, No. 107 Army Hospital, Yantai (264002), ShanDong
Liu Zhaohong, Liao Dening, Zhao Xue, et al.
Objective: To observe the electrophysiological effects of sotalol on patients with atrioventricular accessory pathway and examine the function of sotalol in radiofrequency current ablation (RFCA).
, http://www.100md.com
Methods: Eighteen patients (8 males and 10 females, aged 15～69 years with a mean of 39.8) with atrioventricular accessory pathway including 14 cases of left pathway (2 dominant and 12 recessive) and 4 of right pathway (2 dominant and 2 recessive) were studied. Seldinger′s method was used to introduce catheter electrodes through right internal jugular vein and right femoral vein into the coronary sinus (CS), high right atria (HRA), His bundle (HRE) and right ventricular apex (RVA). After conventional intracardiac electrophysiological examination, 160 mg of sotalol were orally administered, and electrophysiological parameters were then measured five times in succession at intervals of 30 minutes.
, 百拇医药
Results: No significant change was found in P-A, P-R, A-H, H-V and QRS intervals. Bradycardia occurred in 8 cases, but vertigo, fatigue and other symptoms were not observed. The effective refractory periods (ERP) of most of the patients were increased after oral administration of sotalol, as evidenced by the following pairs of electrophysiological data collected before and after the sotalol administration: sinus node recovery time (SNRT), 1 165±209 ms vs. 1 456±371 ms (p<0.05); sinus cycle length (SCL), 724±116 ms vs. 996±178 ms (p<0.05); atrial ERP, 211±24 vs. 243±36 ms (p<0.05); ventricular ERP, 205±11 ms vs. 242±28 ms (p<0.05); anterograde ERP of the atrioventricular node, 269±48 ms vs. 343±97 ms (p<0.05); anterograde ERP of the accessory pathway, 263±45 ms vs. 400±160 ms (p<0.05); retrograde ERP of the accessory pathway, 232±37 ms vs. 289±50 ms (p<0.05); tachycardia cycle, 323±49 ms vs. 382±25 ms (p<0.05); tachycardia-inducing belt, 66±20 ms vs. 30±17 ms (p<0.05); self-termination percentage of induced tachycardia, 67%; QT interval when the atria was stimulated at the rate of 100 times/min, 339±31 ms vs. 364±27 ms (p<0.05). In 3 cases, atrial eletrical stimulation induced atrial fibrillation, but the patients were converted to sinus rhythm 30 minutes after administration of 160 mg sotalol, and atrial electrical stimulation no longer resulted in atrial fibrillation. In one of the 3 cases, RFCA had to be abandoned in the first attempt because of repeated atrial fibrillation, however in the second attempt, after 160 mg of oral sotalol, no atrial fibrillation was induced and RFCA was successful. In 2 cases the induced AVRT was hard to be terminated by rapid electrical stimulation, but it automatically terminated at the anterograde of atrioventricular node and was no longer induced 40 minutes after oral sotalol. RFCA was successfully applied to all of the 18 patients under study. A 10- to 18-months follow-up showed no recurrence.
, 百拇医药
Conclusion: Oral administration of 160 mg of sotalol can increase the ERP of the accessory pathway in both anterograde and retrograde conduction, without blocking conduction of the accessory pathway. When used in RFCA, it can remarkably increase the patient′s endurance, effectively prevent or terminate atrial fibrillation induced by electrical stimulation. Additionally, the use of sotalol in RFCA does not affect the judgement of the effect of RFCA on the accessory pathway., 百拇医药
单位：山东省烟台市，中国人民解放军第107医院 心内科(264002) 刘召红；上海市，中国人民解放军第二军医大学附属长征医院 心内科 廖德宁 赵 学 张家友
关键词：
目的 目的：观察索他洛尔对房室旁道患者心脏电生理的影响，对药物在射频导管消融术(RFCA)中的应用作初步探讨。
方法：18例房室折返性心动过速(AVRT)患者，男8例，女10例，平均年龄39.8(15～69)岁，左侧旁道14例(显性2例，隐匿性12例)，右侧旁道4例(显性2例，隐匿性2例)。Seldinger′s法经右侧颈内及股静脉分别插入冠状窦(CS)、高位右心房(HRA)、希氏束(HRE)及右心室心尖(RVA)导管电极。行常规心内电生理检查后顿服索他洛尔160 mg,于服药后30分、60分、90分、120分、150分重复测量各项电生理参数。
, http://www.100md.com
结果：服药后P-A、P-R、A-H、H-V、QRS间期无明显变化。8例出现窦性心动过缓，但无头晕、乏力、胸闷等不适。窦房结恢复时间(SNRT)1?165±209 ms比1?456±371 ms,窦性周长(SCL)724±116 ms比996±178 ms(P<0.05)。心房有效不应期(ERP)211±24 ms比243±36 ms,心室ERP 205±11 ms比242±28 ms,房室结前传ERP 269±48 ms比343±97 ms,旁道前传ERP 263±45 ms比400±160 ms,旁道逆传ERP 232±37 ms比289±50 ms(P均<0.05)。心动过速周长323±49 ms比382±25 ms,心动过速诱发带66±20 ms比30±17 ms(P<0.05)。诱发性心动过速自行终止率67%。100次/分心房起搏时QT间期339±31 ms比364±27 ms(P<0.05)。3例患者心房/心室电刺激易于诱发心房颤动在服用索他洛尔30分后心房颤动不再诱发。其中1例患者，首次RFCA因术中频发心房颤动而放弃手术，第2次给予索他洛尔160 mg口服，心房颤动不再发作，消融成功。2例心内电刺激难以终止的AVRT，在服药后40分心动过速自行终止于房室结前传，且不再诱发。18例患者均消融成功，随访10～18个月无一例复发。
, 百拇医药
结论：顿服索他洛尔160 mg，吸收好，见效快，可显著延长心脏有效不应期，且不阻断旁道。旁道射频导管消融术中应用可预防或终止电刺激诱发的心房颤动，有效抑制心动过速，提高患者的耐受性，同时不影响手术效果评价。
Electrophysiological Effects of Sotalol on Patients with Atrioventricular Accessory Pathways (Abstract)
Department of Cardiology, No. 107 Army Hospital, Yantai (264002), ShanDong
Liu Zhaohong, Liao Dening, Zhao Xue, et al.
Objective: To observe the electrophysiological effects of sotalol on patients with atrioventricular accessory pathway and examine the function of sotalol in radiofrequency current ablation (RFCA).
, http://www.100md.com
Methods: Eighteen patients (8 males and 10 females, aged 15～69 years with a mean of 39.8) with atrioventricular accessory pathway including 14 cases of left pathway (2 dominant and 12 recessive) and 4 of right pathway (2 dominant and 2 recessive) were studied. Seldinger′s method was used to introduce catheter electrodes through right internal jugular vein and right femoral vein into the coronary sinus (CS), high right atria (HRA), His bundle (HRE) and right ventricular apex (RVA). After conventional intracardiac electrophysiological examination, 160 mg of sotalol were orally administered, and electrophysiological parameters were then measured five times in succession at intervals of 30 minutes.
, 百拇医药
Results: No significant change was found in P-A, P-R, A-H, H-V and QRS intervals. Bradycardia occurred in 8 cases, but vertigo, fatigue and other symptoms were not observed. The effective refractory periods (ERP) of most of the patients were increased after oral administration of sotalol, as evidenced by the following pairs of electrophysiological data collected before and after the sotalol administration: sinus node recovery time (SNRT), 1 165±209 ms vs. 1 456±371 ms (p<0.05); sinus cycle length (SCL), 724±116 ms vs. 996±178 ms (p<0.05); atrial ERP, 211±24 vs. 243±36 ms (p<0.05); ventricular ERP, 205±11 ms vs. 242±28 ms (p<0.05); anterograde ERP of the atrioventricular node, 269±48 ms vs. 343±97 ms (p<0.05); anterograde ERP of the accessory pathway, 263±45 ms vs. 400±160 ms (p<0.05); retrograde ERP of the accessory pathway, 232±37 ms vs. 289±50 ms (p<0.05); tachycardia cycle, 323±49 ms vs. 382±25 ms (p<0.05); tachycardia-inducing belt, 66±20 ms vs. 30±17 ms (p<0.05); self-termination percentage of induced tachycardia, 67%; QT interval when the atria was stimulated at the rate of 100 times/min, 339±31 ms vs. 364±27 ms (p<0.05). In 3 cases, atrial eletrical stimulation induced atrial fibrillation, but the patients were converted to sinus rhythm 30 minutes after administration of 160 mg sotalol, and atrial electrical stimulation no longer resulted in atrial fibrillation. In one of the 3 cases, RFCA had to be abandoned in the first attempt because of repeated atrial fibrillation, however in the second attempt, after 160 mg of oral sotalol, no atrial fibrillation was induced and RFCA was successful. In 2 cases the induced AVRT was hard to be terminated by rapid electrical stimulation, but it automatically terminated at the anterograde of atrioventricular node and was no longer induced 40 minutes after oral sotalol. RFCA was successfully applied to all of the 18 patients under study. A 10- to 18-months follow-up showed no recurrence.
, 百拇医药
Conclusion: Oral administration of 160 mg of sotalol can increase the ERP of the accessory pathway in both anterograde and retrograde conduction, without blocking conduction of the accessory pathway. When used in RFCA, it can remarkably increase the patient′s endurance, effectively prevent or terminate atrial fibrillation induced by electrical stimulation. Additionally, the use of sotalol in RFCA does not affect the judgement of the effect of RFCA on the accessory pathway., 百拇医药