经未闭卵圆孔途径消融左侧房室旁路  

Atrioventricular reentrant tachycardia ablation performed via patent foramen ovale

作　　者：易忠 王斌 周学继[2] 李小龙 

机构地区：[1]北京大学航天临床医学院心脏中心,北京100049 [2]唐山市丰润区第二人民医院心内科

出　　处：《中华临床医师杂志（电子版）》2010年第7期1012-1016,共5页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的探讨经未闭卵圆孔途径消融左侧房室旁路的可能性及安全性。方法 2008年1月至2009年3月,共41例左侧房室折返性心动过速患者,平均年龄(47.0±16.8)岁,接受射频消融治疗。经电生理检查证实左侧旁道后,所有患者均先用导管探试是否存在未闭卵圆孔。存在未闭卵圆孔者经未闭卵圆孔消融;反之,经股动脉途径消融。比较经卵圆孔途径和经动脉途径两种方法射频消融的手术成功率、手术时间、X线曝光时间以及副作用发生情况。术后所有患者接受电话随访。结果共11例经未闭卵圆孔途径完成,其余30例患者经穿刺右侧股动脉途径消融(其中2例改经穿刺房间隔途径消融成功)。其中两组手术时间分别为(56.3±14.2)min和(60.3±18.2)min(P=0.076),X线曝光时间分别为(9.1±3.9)min和(9.5±4.2)min(P=0.115)。探测是否存在未闭卵圆孔需要(4.7±1.2)min。股动脉途径组有穿刺部位血肿、瘀斑5例,心包填塞1例。术后随访平均13个月(3～21个月),两组均无心动过速复发,亦未见其他并发症。结论经未闭卵圆孔途径消融左侧房室折返性心动过速安全、简单、快捷,值得在穿刺股动脉之前确定患者是否存在未闭卵圆孔。Objective To evaluate the possibility and safety of left accessory pathway ablation from the patent foramen ovale.Methods From January 2008 to March 2009,a total of 41 patients with left atrioventricular reentrant tachycardia patients(mean age 47.0 ± 16.8 years) received radiofrequency ablation.After confirmed the left side of the bypass by electrophysiological examination,all patients were received first test the existence of patent foramen ovale with the catheter probe.After confirmed the left accessory pathway,the patients were ablated through the patent foramen ovale,while the remaining patients underwent RFCA via the transfemoral approach(controls) .These two methods were compared with the ablation success rate,the total procedure time,the fluoroscopic time and the occurrence of side effects.After 3-18 months,all patients received telephone follow-up.Results All patients had successful ablation,of which 11 patients ablated from patent foramen ovale and the remaining 30 patients via the right femoral artery approach.In control group,5 patients suffered from hematoma in puncture site and 1 case suffered from acute cardiac tamponade during ablation.She was received second RFCA via transseptal approach 20 days after the fist procedure.The total procedure time was 56.3 ± 14.2 min vs.60.3 ± 18.2 min,P = 0.076;the fluoroscopic time was 9.1 ± 3.9 min vs.9.5 ± 4.2 min,P = 0.115.To detect the existence of the foramen ovale required additional 4.7 ± 1.2 min.There was no recurrence of arrhythmia in either group during follow up.Neither cerebral infarction,embolism,nor migraine headache were detected during the follow up.Conclusions The left-sided Aps ablation performed via patent foramen ovale is simple,fast and safe.It's worth to test the existence of the patent foramen ovale before the left-sided APs ablation.

关 键 词：心动过速 房室结折返性 卵圆孔 未闭 导管消融术 左侧房室旁路 

分 类 号：R541.1[医药卫生—心血管疾病]