Impact Of Atrioventricular Nodal Slow Pathway Ablation On Coronary Sinus Electrophysiology In Patients With AVNRT

Objective:This paper aims to discuss coronary sinus (CS)electrophysiology changes and its mechanism in patients with atrioventricular nodal reentrant tachycardia(AVNRT) after atrioventricular nodal slow pathway ablation.Methods:Forty-eight cases with cardiac electrophysiological examination confirmed diagnosis of AVNRT, are obeserved A wave conduction sequence of CS in sinus rhythm and pacing in the proximal of CS(CSp)CS9～10, the middle of CS(CSm)CS5～6, the distal of CS(CSd)CSi～2 and were measured the ERP of CSp, CSm, CSd after atrioventricular nodal slow pathway ablation. Using the program of S1S1 500ms,400ms,350ms,300ms,280ms to pace CSp or CSd, and were measured A wave conduction time of CSp～CSd or CSd-CSp.Results:(1) A wave conduction sequence of CS in sinus rhythm,the oblique type 31 (31/48), accounting for 64.58%; the arc type 17(15/48), accounting for 35.42%. (2)While pacing CSp, A wave conduction sequence of CS from CSp to CSd is oblique type, CSm pacing, A wave conduction sequence of CS from CSm to CSp or CSd is oblique type, CSd pacing, A wave conduction sequence of CS from CSd to CSp is oblique type. (3)The ERP of different parts of CS after atrioventricular nodal slow pathway ablation released respectively: CSp(213.75±24.98)ms,(223.54±16.44)ms,P<0.00001;CSm(222.71±22.67)ms,(2 30.00±14.14)ms,P<0.001;CSd(229.17±36.83)ms,(235.83±22.86)ms,P<0.05.The ERP dispersion of CS after atrioventricular nodal slow pathway ablation released respectively:(26.88±25.94)ms,(20.83±13.81)ms,P<0.05.(4)The patients with A wave conduction sequence of CS is oblique or curved type, using the program of S1S1500ms,400ms,350ms,300ms,280ms to pace CSp or CSd, the differences of A wave conduction time of CSp-CSd or CSd-CSp after atrioventricular nodal slow pathway ablation show no significance. (5)Using the program of S1S1 500ms,400ms,350ms,300ms,280ms to pace CSp or CSd, the differences of A wave conduction time on all patients of after atrioventricular nodal slow pathway ablation of CSp-CSd or CSd-CSp are not statistically significant.Conclusions:After atrioventricular nodal slow pathway ablation in patients with AVNRT, the ERP of CSp, CSm, CSd are prolonged, while the ERP dispersion of CS is decreased, but A wave conduction time of CS is not obviously changed. The reason for this phenomenon may be related to the atrioventricular nodal slow pathway ablation cause vagal function to change.