Para-Hisian pacing - A new method for differentiating retrograde conduction over an accessory AV pathway from conduction over the AV node
Para-Hisian pacing - A new method for differentiating retrograde conduction over an accessory AV pathway from conduction over the AV node
复制标题
DOI：
10.1161/01.cir.94.5.1027
复制
发表时间：
1996-09-01
期刊：
影响因子：
37.8
通讯作者：
Jackman, WM
中科院分区：
文献类型：
--
作者：
Hirao, K;Otomo, K;Jackman, WM
背景 区分旁路 AV 通路 (AP) 和 AV 结 (AVN) 上的心室心房 (VA) 传导可能很困难，特别是对于室间隔 AP 患者。 方法和结果 在 149 名患有 AP 的患者和 53 名患有房室结折返性心动过速 (AVNRT) 的无 AP 患者中测试了一种新的起搏方法，即旁希斯起搏。心室起搏在希氏束和近端右束支 (HB-RB) 附近进行，最初以高输出捕获 RV 和 HB-RB。然后降低输出以失去 HB-RB 捕获。检查了 HB-RB 捕获和非捕获之间逆行心房激动的时间和顺序的变化。 HB-RB 捕获丧失而刺激心房 (S-A) 间期或心房激活序列没有变化表明仅逆行 AP 传导。 S-A 间期增加，而希束-心房间期或心房激动序列没有变化，表明仅存在逆行 AVN 传导。心房激动序列的变化表明存在逆行 AP 和 AVN 传导。 Para-Hisian 起搏正确识别了 147 名 AP 患者中的 132 名逆行 AP 传导，包括所有间隔和右游离壁 AP。 34 名左游离壁 AP 患者中的 9 名和 9 名永久性交界性往复性心动过速患者中的 6 名患者中，逆行 AVN 传导掩盖了 AP 传导。 Para-Hisian 起搏正确排除了所有 53 名 AVNRT 患者的 AP 传导。结论 Para-Hisian 起搏可靠地识别了间隔和右侧游离壁 AP 上的逆行传导，但 AVN 传导可能会掩盖远离起搏部位或逆行传导时间较长的 AP。
Background Differentiation between ventriculoatrial (VA) conduction over an accessory AV pathway (AP) and the AV node (AVN) may be difficult, especially in patients with a septal AP.Methods and Results A new pacing method, para-Hisian pacing, was tested in 149 patients with AP and 53 patients without AP who had AV nodal reentrant tachycardia (AVNRT). Ventricular pacing was performed adjacent to the His bundle and proximal right bundle branch (HB-RB), initially at high output to capture both RV and HB-RB. The output was then decreased to lose HB-RB capture. The change in timing and sequence of retrograde atrial activation between HB-RB capture and noncapture was examined. Loss of HB-RB capture without change in stimulus-atrial (S-A) interval or atrial activation sequence indicated exclusive retrograde AP conduction. An increase in S-A interval without change in His bundle-atrial interval or atrial activation sequence indicated exclusive retrograde AVN conduction. A change in atrial activation sequence indicated the presence of both retrograde AP and AVN conduction. Para-Hisian pacing correctly identified retrograde AP conduction in 132 of 147 AP patients, including all septal and right free wall APs. Retrograde AVN conduction masked AP conduction in 9 of 34 patients with a left free wall AP and 6 of 9 patients with the permanent form of junctional reciprocating tachycardia. Para-Hisian pacing correctly excluded AP conduction in all 53 patients with AVNRT.Conclusions Para-Hisian pacing reliably identifies retrograde conduction over septal and right free wall APs, but AVN conduction may mask APs located far from the pacing site or with a long retrograde conduction time.