多旁道射频消融回顾性分析  

Retrospective Analysis of Radiofrequency Catheter Ablation of Tachycardia Caused by Multiple Accessory Pathways

作　　者：李淑敏[1] 郭涛[1] 张代民[1] 韩明华[1] 刘中梅[1] 赵玲[1] 

机构地区：[1]昆明医学院第一附属医院心内科,昆明650032

出　　处：《昆明医学院学报》2004年第4期80-82,共3页Journal of Kunming Medical College

摘　　要：目的 :对 33例接受射频消融治疗的多旁道病例分析 ,总结多旁道所致心动过速的电生理特征、消融方法及消融结果 .方法 :男性 2 2例 ,女性 11例 ,年龄 [4 0 2± 9 7(15～ 6 8) ]岁 ,电生理检查及射频消融术一次完成 .结果 :33例患者左侧双旁道 18例 ,右侧双旁道 4例 ,左侧并右侧双旁道 10例 ,左侧并右侧三旁道 1例 . 33例 6 7条旁道行 4 0次电生理检查及射频消融术治疗 ,成功率 10 0 % .其中 15例术中诱发出两种不同形态、不同频率的心动过速 ,6例诱发出两种不同频率的心动过速 ,分别或同时标测 ,分别消融 ;5例一条旁道消融后 ,再次诱发心动过速 ,经标测证实为另一条旁道所致并消融阻断 ;6例双旁道及 1例三旁道患者经第一次消融阻断 1条及 2条旁道后 ,经电生理检查无旁道依据 ,也未诱发心动过速 ,但术后 1～ 2 4个月再发心动过速 ,再次电生理检查证实为另 1条旁道所致 ,又一次消融 .随访 5～ 72月 ,无 1例复发 .结论 :多旁道电生理表现极为复杂 ,给诊断及治疗带来一定的难度 ,诊断主要靠详细的电生理检查 ,消融应采用“剥笋”方法 ,多旁道的消融顺序为 :①先显性后隐性 ;②左右同时标测 ;③先侧壁后间隔 .Objective: To summarize electrophysiological characteristics through analyzing radiofrequency catheter ablation of tachycardia caused by multiple accessory pathways in 33 cases. Methods: This study included 33 patients, male 22, female 11, mean age [40.2±9.7(15～68)] years old. Electrophysiological examination and radiofrequency catheter ablation were finished one time. Results: Among 33 patients, double pathways 32 cases (left double pathways 18 cases, right double pathways 4 cases, bilateral pathways 10 cases); triple pathways 1 case (left pathway and right double pathways); 33 cases of all patients with 67 pathways were ablated successfully 40 times respectively after final diagnosis of tachycardia caused by multiple through electrophysiological examinations; rate of success was 100 percent; tachycardia with different shape and different frequency were evoked in 15 cases; Tachycardia with two different frequency in 6 cases was mapped and ablated respectively; another pathway in 5 cases, which was again confirmed after one pathway was ablated, was ablated; 6 cases of double pathways and 1 case of triple pathways had neither evidence of accessory pathway by electrophysiological examination, nor tachycardia excited after the first successfully ablation. However, tachycardia recurred from 1st month to 24th month after operation, confirmed by the electrophysiological reexamination, and ablated successfully again. During 5～72 months of follow-up, no complications was found. Conclusion: Diagnosis of multiple accessory pathways was basis of electrophysiological examination but manipulative complexity of electrophysiological multiple accessory pathways lead to practical difficulty. Bamboo-peeling method of ablation should be adopted. Sequences of multiple pathways ablation are: first, dominant accessory pathways are ablated before dormant accessory pathways done; second, left and right target points are mapped at the same time; third, lateral walls are ablated before septum done.

关 键 词：旁道 消融 心动过速 电生理检查 诱发 诊断 左侧 治疗 显性 形态 

分 类 号：R541[医药卫生—心血管疾病] R654.2[医药卫生—内科学]