| ObjectiveThrough checking the esophagus atrial adjustable stroke and combined with atropine test contrast atrioventricular conduction system changes in electrophysiological parameters to judge the atrioventricular conduction function.MethodsFor this study during January2012to December2012in our hospital outpatient or hospitalization for bradycardia sinoatrial node, and heart palpitations check because of atrioventricular node functionas the research object in124patients of esophageal atrial cardiac surgery (TEAP), age16-60years old, average age42.6±13.0, among which85were male, female39cases.Selected patients were divided into2groups:tachycardia group56cases,35cases of men, women,21cases (age16-57years old, average39.2±13.5years).Bradycardia group68cases,48cases of men and women in20cases (age16to59years old, average44.5±15.6years).All patients in preoperative outage five half-life anti-arrhythmic drugs, parallel and conventional dynamic ecg examination.TEAP use electronic instrument factory in suzhou, east production type of DF-5a digital cardiac electrophysiology stimulator, from patients with nasal7f quadrupole catheter insertion, adjusting pacemaker voltage, gives the programmed stimulation method (S1S1), have been increasing in different stimulus detection wien points and2:1stuck points, after be programmed stimulation method (S1S2) reverse scan (step-10ms), the determination of atrioventricular conduction, should not be (AVERP).Selected from124cases of patients with atrioventricular conduction function to reduce the74cases, including tachycardia group of27cases,47cases of bradycardia group, to atropine (0.03-0.04mg/kg) after intravenous injection, with sinus heart rate after heart rate for30s fastest, start increasing repeat S1S1S1S2reverse scan and stimulation to retest wien points, stuck points and AVERP2-1.Determination of contrast before and after medication atrioventricular conduction system electrophysiological parameters change as a result, to diagnosis and differential diagnosis of atrioventricular block is functional, or pathological.Results1.124patients in the conventional electrocardiogram detection atrioventricular block30cases (24.2%) and dynamic ecg detection atrioventricular block34cases (27.4%), atrioventricular block TEAP detected74cases (59.7%), regular and dynamic electrocardiogram detection atrioventricular block all can by TEAP detection, TEAP of atrioventricular block was much higher than regular and dynamic electrocardiogram (P<0.05).2. TEAP selected74cases of atrioventricular conduction function to reduce patients, male was obviously higher than female (male54cases, women in20cases, about3:1), with statistical significance (P<0.05).3. TEAP detection atrioventricular conduction function to reduce the74cases, including tachycardia group of27cases,47cases of bradycardia group, to atropine (0.030.04mg/kg) into the static effects of atrioventricular conduction function:3.1atropine with faster heart rates and RR period shorten, RR interphase reduced from823.7±124.0ms and823.7±68.2ms, was statistically significant (P<0.05).3.2tachycardia group:①atropine affect wien points:27samples’s point goes on to the normal range (>130PPM) normally, wien points by107.4±13.8PPM to164.8±11.6parts per million, compared before and after medication was statistically significant (P<0.05);②atropine on2:1stuck points:27cases of2:1stuck points goes on to the normal range (>150PPM) normally,2:1stuck points by127.4±15.8PPM to185.6±10.5parts per million, compared before and after medication was statistically significant (P<0.05).③atropine to AVERP shadow:27cases AVERP reduced to normal range (230-430ms), reduced from521.1±92.7ms and521.1±43.4ms, compared before and after medication have significant difference (P <0.05).3.3.3atropine AVERP impact:42cases AVERP reduced to the normal range, reduced from527.4±91.8ms and527.4±52.4ms, compared before and after medication have significant difference (P<0.05);The drug was only5cases AVERP still extend, reduced from520.0±33.2ms and498.0±30.3ms, compared before and after medication there was no significant difference (P>0.05).After intravenous injection atropine,74patients,69cases of group (27cases of tachycardia group, bradycardia42) wien points,2:1stuck points and AVEPR returned to normal, for increased vagus nerve tension type atrioventricular block, only5cases (group are bradycardia) wien points,2:1stuck points and AVEPR for pathological atrioventricular block has no obvious change.Conclusions1. TEAP of atrioventricular block detection rate is significantly higher than the conventional and dynamic electrocardiogram (ecg).2. TEAP combined with atropine experiments can be used for differential diagnosis of vagus type atrioventricular block and pathological atrioventricular block.3. Tachycardia functional atrioventricular block detection rate is higher than bradycardia groups; Pathological atrioventricular block detection bradycardia group was obviously higher than that of tachycardia group. |
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