文档介绍：702例房室结折返性心动过速的射频消融治疗
(作者:___________单位: ___________邮编: ___________)
作者:齐书英何振山崔俊玉李洁李育红
【摘要】目的回顾性总结射频消融术治疗702例慢快型房室结折返性心动过速(AVNRT)的疗效及安全性。方法所有病例均先行心内电生理检查,明确诊断后,以中、下位法行射频消融,结合影像学和腔内电图确定靶点。%,%,%,无死亡病例。结论射频消融治疗AVNRT成功率高,并发症少,复发率低,以中位法消融、延长单次有效放电时间、消融后房室结不应期延长且达到慢径消失,可有效提高AVNRT的消融成功率,且明显降低术后复发率,寻找有效靶点,细致操作能有效预防并发症发生,心房起搏有一定价值。
【关键词】射频电流; 导管消融; 房室结折返性心动过速; 房室结双径路
【Abstract】 Objective To retrospectively sum up the efficacy and safety of radiofrequency ablation in patients with dual atrioventricular nodal pathways. Methods The slow pathways were ablated in 702 patients with dual atrioventricular nodal pathways, some parameters were studied. Results The essful rate was %, and plication rate was %, and the recurrence rate was %. There was no death. Conclusion Slow pathway ablation in patients with dual atrioventricular nodal pathways has high essful rate, plication rate and recurrence rate. To increase the essful rate and l
ower the recurrence rate, methods were used such as ablation at medium position, prolongation of single ablation time, disappearance of slow pathways. Atrial pacing is of some value to the ablation.
【Key words】 Radiofrequency current;Catheter ablation;Atrioventricular nodal reentrant tachycardia;Dual atrioventricular nodal pathway
房室结折返性心动过速(atrioventricular nodal reentrant tachycardia,AVNRT)是常见的阵发性室上性心动过速,已证实房室结双径路是其发生和维持的电生理基础[1]。经导管射频消融(radiofrequency catheter ablation,RFCA)治疗已成为AVNRT的首选治疗方法,%[2]。我科自1992年开展射频消融治疗阵发性室上性心动过速,现回顾性总结702例射频消融治疗的AVNRT患者的临床资料,以期评价射频消融治疗AVNRT的疗效及安全性。
1 临床资料
病例选择入选病例来自1994年1月~2008年10月在我院行射频消融治疗的慢
快型AVNRT患者702例,其中男327例,女375例,年龄7~80(44±12)岁;病程1 d~50年,合并高血压病72例,糖尿病58例,冠心病23例,右位心1例。其余患者经临床检查无器质性心脏病证据。以中位法行射频消融的患者592例,年龄7~80(46±17)岁,男275例,女317例,病程5 d~50年,%;以下位法行射频消融的患者110例,年龄15~76(44±15)岁,男52例,女58例,病程1 d~48年,%。两组患者的基本情况差异无统计学意义(P>)。
术前准备术前停用抗心律失常药物至少5个半衰期,常规查血、尿、便常规,肝、肾功能、电解质、血糖,血凝四项,心电图、胸片和超声心动图,部分患者查食道心房调搏。
电生理检查常规穿刺右颈内静脉或锁