Original Articles Korean Circulation J 2002;323:241-250 아데노신투여로방실결절내이중전도로의진단시 관찰되는방실차단의의의 한승환 1 김영훈 1 이현수 1 이호준 1 신성희 1 박창규 1 서홍석 1 심완주 1 오동주 1 노영무 1 황교승 2 Significance of Atrio-Ventricular Block Following Atrio-His Jump in the Diagnosis of Dual Atrioventricular Nodal Physiology with Adenosine Infusion Seung Hwan Han, MD 1, Young-Hoon Kim, MD 1, Hyun Soo Lee, MT 1, Hojun Rhee, MD 1, Sung Hee Shin, MD 1, Chang Gyu Park, MD 1, Hong Seog Seo, MD 1, Wan Joo Shim, MD 1, Dong Joo Oh, MD 1, Young Moo Ro, MD 1 and Gyo Seung Hwang, MD 2 1 Department of Internal Medicine, Korea University, Seoul, 2 Department of Internal Medicine, Ajou University, Suwon, Korea ABSTRACT Background and ObjectivesAtrioventricular block AVB is frequently seen following atrio-his AH interval lengthening after adenosine injection during sinus rhythm when both the fast and slow pathways are blocked in patients with dual atrioventricular nodal physiology DAVNP. However, the condition also occurs in patients without DAVNP. Therefore, an AH jump may not indicate DAVNP if AVB is accompanied. The goal of this study was to use a low dose 69 mg of adenosine to determine whether an AH jump truly represents DAVNP when the presence or absence of AVB following the AH jump is taken into consideration. Subjects and MethodsThis study included 78 patients malefemale4731, age 40.015.7 years, DAVNP group, n46, control group, n32. Adenosine 69 mg was administered intravenously during sinus rhythm. The inclusion criteria of DAVNP were either induced AVNRT n37common type, n35, uncommon, n2 or identification of AH jump n9 during elctrophysiology study EPS. The control group consisted of patients without evidence of DAVNP and noninducible AVNRT on EPS. In all subjects, the electrophysiologic parameters of the AV nodal properties were tested. ResultsIn the DAVNP group, intravenous adenosine during sinus rhythm resulted in an AH jump without AVB 8/46, 17.4%, an AH jump followed by AVB 9/46, 19.6%, an AH jump accompanied by induced AVNRT 1/46, 2.1%, or no significant changes in the AH interval 28/46, 60.9%. In the control group, none of the subjects showed an AH jump without AVB, however an AH jump with subsequent AVB was observed in 4 of 32 subjects 12.5%. If the finding of an AH jump without AVB alone was considered as a positive criteria of DAVNP, its specificity 87.5% to 100% and positive predictive value 81.8% to 100% increased compared to the criteria defined by an AH jump regardless of the presence or absence of AVB, however, its sensitivity decreased from 39.1% to 241
19.6%. ConclusionAH jump induced by adenosine injection may not indicate DAVNP if AVB follows. Korean Circulation J 2002;323:241-250 KEY WORDSTachycardia, atrioventricular nodal reentryadenosineheart block. 서론 242 대상및방법 대상 Table 1. Subjects of study group n78, age40.015.7 years, MF4731 Dual AV nodal physiology group n46 Inducible AVNRT n37 common35, uncommon2 Not inducible AVNRT but, AH jump on atrial extrastimuli n9 Control group n32 AVatrio-ventricular, AVNRTatrioventricular nodal reentrant tachy-cardia, AHatrio-his Korean Circulation J 2002;323:241-250
방법 통계분석 결과 동율동에서아데노신정주후의반응양상 243
Fig. 1. Response after adenosine injection during sinus rhythm in group with dual AV nodal physiology and control. AHatrio-his, AVBatrioventricular block, AVNRT atrioventricular nodal reentrant tachycardia, AVatrioventricular. 동율동하에서아데노신정주후보이는방실차단을동반하는 AH jump의의의 AH jump를보인이중전도로군에서방실차단유무에따른전기생리적지표의차이 Fig. 2. AH jump with AV block after adenosine injection during sinus rhythm. AHatrio-his, AVatrioventricular. 244 Korean Circulation J 2002;323:241-250
Fig. 3. AH atrio-his jump without AV atrioventricular block after adenosine injection during sinus rhythm. Fig. 4. Wenckebach AV atrioventricular block after adenosine injection during sinus rhythm. AVNRT 환자에서완속전도로완전절제후동율동에서아데노신정주후양상 245
고 Fig. 5. Sensitivity, specificity, positive predictive value, and negative predictive valuecomparison between two difinition of dual AV atrioventricular nodal physiology according to presence or absence of AV block following AH atrio-his jump. 찰 Table 2. Comparison of electrical parameters between AH jump without AV block patients and AH jump with AV block patients in dual AV nodal physiology group Unitmsec AH jump without AV block n8 AH jump with AV block n9 SCL 736.6138.2 712.671.5 NS AH interval 80.5 19.7 85.318.0 NS HV interval 44.0 5.6 46.7 6.8 NS QRS duration 83.9 17.2 80.1 7.7 NS TCL 312.4 64.5 356.692.8 NS AH interval during tachycardia 184.1 70.8 204.967.7 NS HV interval during tachycardia 50.3 9.4 47.6 8.4 NS Fast pathway ERP 351.4 88.4 368.881.3 NS Slow pathway ERP 282.5 38.6 305.775.9 NS AERP 211.4 20.4 200.021.6 NS AVBCL 328.8 48.2 410.099.8 p0.05 Maximal AH interval after adenosine injection 246.1 49.4 300.488.9 NS Values are expressed as meansd Mann-Whitney U test. AHatrio-his, AVatrioventricular, SCLsinus cycle length, NSnot significant, HVhis-ventricular, TCLtachycardia cycle length, ERPeffective refractory period, AERP atrial effective refractory period, AVBCLatrioventricular block cycle length p 246 Korean Circulation J 2002;323:241-250
Fig. 6. Change in AH interval with adenosine injection before and after slow pathway elimination in AVNRT patient. AHatrio-his, AVatrioventricular, AVNRTatrioventricular nodal reentrant tachycardia. Fig. 7. Pattern after adenosine injection before and after slow pathway elimination in AVNRT patient. AVatrioventricular, AHatrio-his, AVNRTatrioventricular nodal reentrant tachycardia. 247
248 본연구의제한점 본연구의임상적인의미 요약 배경및목적 : Korean Circulation J 2002;323:241-250
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