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目的 :探讨利用阈下刺激 (STS)定位房室结折返性心动过速 (AVNRT)的慢径消融靶点的临床应用价值。方法 :选择AVNRT患者 6例 ,经常规电生理检查明确诊断后 ,将大头电极放在冠状窦口下缘与希氏束之间的中下区域进行标测 ,测定该点的起搏阈值后 ,诱发AVNRT ,然后发放STS终止AVNRT ,在终止位点处试消融 ,观察STS标测消融的有效性 ;在非终止位点处 ,结合局部心内电图判断是否进行试消融 ,如在非终止位点处试消融 ,观察STS标测的可靠性。同时观察STS标测定位的安全性。结果 :在 6例患者中 ,有 3例STS终止了持续性AVNRT ,且在终止位点处试消融并获得成功 ;有 5例共在 10个位点处发放了STS ,其中在 9个位点未终止心动过速 ,在这些非终止位点处试消融均未获得成功 ,非 1个位点出现了心房夺获。所有患者在STS标测过程中 ,未出现心房颤动、心动过速的加速或心室颤动等现象。结论 :STS终止AVNRT的位点是判断消融靶点的一个良好的电生理学指标。STS标测定位是安全、有效和可靠的一种方法 ,值得进一步地深入研究
Objective: To investigate the clinical value of subacute stimulation (STS) in targeting slow pathway ablation of atrioventricular nodal reentrant tachycardia (AVNRT). Methods: Six patients with AVNRT were selected. After definite diagnosis by routine electrophysiological examination, large electrodes were placed in the middle and lower area between the lower edge of coronary ostium and His bundle. After determining the pacing threshold of this point, Evoked AVNRT, and then issued STS termination of AVNRT, ablation at the termination site to observe the effectiveness of STS mapping ablation; at the non-stop site, combined with local cardiogram to determine whether to try ablation, such as non-stop bit At the point of ablation, observe the reliability of STS mapping. At the same time observe the safety of STS mapping positioning. RESULTS: Of the 6 patients, 3 had discontinued persistent AVNRT by STS and were successfully ablated at the termination site. STSs were distributed in 5 of 10 sites, of which 9 Unstretched tachycardia was not successful at any of these non-stop sites, with atrial seizures not occurring at 1 site. All patients in the STS mapping process, no atrial fibrillation, tachycardia accelerated or ventricular fibrillation and so on. Conclusion: The termination of AVNRT by STS is a good electrophysiological criterion for judging the target of ablation. STS mapping positioning is a safe, effective and reliable method that deserves further study