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目的探讨动态心电图心率波动频谱分析对选择性消融窦房结与房室结周围神经治疗缓慢性心律失常患者的作用。方法选择症状严重、拟行起搏器治疗的阵发性心动过缓患者35例,术前行动态心电图检查并进行心率波动频谱分析。对于症状及频谱分析支持心动过缓为迷走神经张力增高所致的患者,在X线与64排螺旋CT心脏解剖影像指导下,标测窦性心律下的心房激动顺序,围绕并避开心房最早激动点和His束区域,记录心内电图神经组织电位,温控射频消融,观察消融反应,随访治疗效果。结果成功的30例患者中,28例高频成分(HF)明显,低频成分(LF)存在;2例为LF缺失,HF明显。复发的5例患者中4例为LF缺失,HF明显;1例为HF明显,LF存在。术后动态心电图检查,成功的30例患者中17例HF明显降低,余无明显变化。复发的5例患者中1例HF明显降低,余无明显变化。电生理检查显示,消融后患者基础心率、SNRT、WP、AH间期都得到了明显改善(P<0.01)。结论对于心率波动频谱分析支持心动过缓系由迷走神经张力增高所致的患者,选择性消融窦房结或房室结周围神经有较好治疗效果。
Objective To investigate the effect of dynamic electrocardiogram heart rate fluctuation spectrum analysis on patients with bradyarrhythmia by selective ablation of the sinus node and atrioventricular nodal nerve. Methods Thirty-five patients with paroxysmal bradycardia who had severe symptoms were enrolled in this study. Preoperative dynamic ECG and frequency spectrum analysis of heart rate were performed. For patients with symptomatic and spectrum analysis supporting bradycardia as a result of increased vagal tone, under the guidance of X-ray and 64-slice spiral CT cardiac anatomical images, the atrial activation sequence under sinus rhythm was measured around and avoiding the earliest atrial agitation Points and His beam area, recording the ECG ECG, temperature control radiofrequency ablation, observation of ablation, follow-up treatment. Results Among 30 successful patients, 28 cases had high frequency (HF) and low frequency (LF), 2 cases had LF deficiency, and HF was obvious. Four of the five patients who relapsed were LF-deficient with significant HF, one with HF, and the other with LF. Postoperative ambulatory electrocardiogram, the successful 30 patients in 17 cases of HF was significantly lower, I no significant change. One of the five recurrent cases of HF was significantly lower, with no significant change. Electrophysiological examination showed that the baseline heart rate, SNRT, WP and AH interval were significantly improved after ablation (P <0.01). CONCLUSIONS: Spectrum analysis of heart rate fluctuations supports the treatment of patients with bradycardia that is caused by increased vagal tone and has the potential to selectively ablate sinoatrial node or atrioventricular nodal nerve.