心功能障碍患者心动过速的射频消融治疗  

The Safety of Radiofrequency Current Ablation of Tachycardia in Patients With Cardiac Dysfunction

作　　者：侯应龙[1] 陈漠水[2] 苏雨江[2] 陆士娟[2] 邢波[2] 杜子军[2] 俸永红[2] 梁其贵[2] 杜日映[3] 娄兹谟[1] 

机构地区：[1]山东大学临床医学院山东省千佛山医院心内科,山东济南250014 [2]海口市心血管病研究所海口市人民医院心内科 [3]青岛市心血管病研究所青岛市海慈医院心内科

出　　处：《中国心脏起搏与心电生理杂志》2004年第4期311-312,共2页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：探讨射频消融 (RFCA)治疗心功能障碍患者心动过速的安全性。对 36例不同程度心功能障碍患者采用药物或介入方法治疗原发病、纠正心功能、RFCA根治心动过速。结果 :经术前准备 ,所有患者心功能均改善 1～ 2级 ,恢复至NYHAⅡ～Ⅰ级以上。首次消融成功 33例 ,成功率 91.7% (33/ 36 )。未成功的 3例中 ,2例 (1例左中间隔旁道及 1例右前壁旁道 )行第 2次消融成功 ,1例不纯性心房扑动消融 2次均未成功改服胺碘酮疗效确切。总成功率97.2 % (35 / 36 )。 6例合并冠心病心绞痛的患者有 4例行左前降支经皮冠状动脉成形术及支架置入术 ,2例行RFCA后心绞痛不再发作。 2例合并风湿性心脏病者有 1例同期行二尖瓣球囊扩张成形术 ,1例择期外科换瓣。经 6 .4±2 .4 (2～ 10 )年的随访无 1例复发。结论 :认真做好围术期处理 ,心功能障碍患者心动过速的RFCA治疗同样具有高成功率和高安全性。To investigate safety of radiofrequency current ablation(RFCA)of tachycardia in patients with cardiac dysfunction, tachycardias were treated by means of RFCA in 36 patients with different degree of cardiac dysfunction. Results:Having been prepared preoperatively, cardiac function(NYHA) of all patients were improved at least 1～ 2 classes, and recovered to class Ⅱ～Ⅰ.The first RFCA were successful in 33 patients with success rate of 91.7%(33/36). Of 3 patients with failured RFCA, 2 patients,1 with left midseptal accessory atrioventricular pathway(AP) and 1 with right anterior free wall AP , were successfully ablated at second time. Two-time RFCAs were failure in 1 with impured atrial flutter who took amiodarone. Therefore, total success rate was 97.2%(35/36). Of 6 patients with angina pectoris, 4 received percutaneous transluminal coronary angioplasty & stenting, 2 had no angina onset following RFCA. Of 2 patients with rheumatic heart diseases, 1 patient received percutaneous mitral balloon valvularoplasty at the same time, 1 patient selective valve replacement. No tachycardia was recurrent in all patients during follow-up of 6.4±2.4(2～10)years. Conclusion: RFCA of tachycardia was also safe in patients with cardiac dysfunction based on excellent perioperative preparations.

关 键 词：心血管病学 心功能障碍 心动过速 导管消融 射频电流 

分 类 号：R541.71[医药卫生—心血管疾病] R454.1[医药卫生—内科学]