下腔静脉、三尖瓣环峡部的射频消融治疗心房朴动  

Radiofrequency ablation at Inferior-tricuspid isthmus to treat atrial flutter

作　　者：马坚[1] 王方正[1] Nadir Saoudi 张奎俊[1] 余培桢[1] 王锦志[1] 李一石[1] 华伟[1] 楚建民[1] 方丕华[1] 田瑞国[1] 朱克平[1] 鲁志民[1] 孙瑞龙[1] 陈新[1] 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院,100037 [2]法国Rouen 大学 Charles Nicolle 医院

出　　处：《中华心律失常学杂志》1997年第1期27-31,共5页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的:报道以下腔静脉、三尖瓣环峡部双向传导阻滞作为终点的心房扑动射频消融方法,观察该终点对长期疗效的作用。方法:对5例Ⅰ型心房扑动患者的下腔静脉、三尖瓣环峡部进行射频消融。根据右房下侧壁和冠状静脉窦口起搏的右房激动顺序和传导时间变化,评价峡部传导阻滞。术后门诊随访观察。结果:5例患者分别于心房扑动(2例)和窦性心律(3例)时接受射频消融治疗,消融后峡部均发生双向传导阻滞。右房下侧壁和冠状静脉窦口起搏的右房激动顺序分别呈顺时针和逆时针单一方向,右房传导时间分别延长82和78ms。随访4个月无一例复发。结论:峡部双向传导阻滞是射频消融心房扑动成功的可靠标志。在窦性心律下,亦可对Ⅰ型心房扑动患者进行消融。Objective:To study the radiofrequency catheter ablation of atrial flutter by using the bidirectional conduction block at the inferior vena cava-tricuspid annulus isthmus as an endpoint,and also to observe the effects of this endpoint on long-term outcome of ablated patients.Methods:Radiofrequency ablation targeting the inferior vena cava-tricuspid annulus isthmus was performed in five patients with type Ⅰ atrial flutter.The block of isthmus was assessed by changes in right atrial activation sequence and conduc- tion time while pacing from low lateral right atrium and proximal coronary sinus.After ablation all patients were followed in outpatient clinic.Results:Radiofrequency ablation was performed during atrial flutter in 2 patients or during sinus rhythm in 3 patients,and comeplete isthmus bidirectional block was achieved in all five patients.After ablation,the right atrial activation sequence was in only clockwise direction with an increase of 82ms in the conduction time when low lateral right atrium was paced,and in only counterclock- wise direction with an increase of 78ms in conduction time when proximal coronary sinus was paced.During a follow-up of 4 months,no patient experienced atrial flutter recurrence.Conclusion:Isthmus bidirec- tional conduction block is a reliable marker for successful atrial flutter ablation.For patient with clinical type Ⅰ atrial flutter,ablation procedure can be performed in sinus rhythm.

关 键 词：峡部 下腔静脉 三尖瓣 传导阻滞 患者 射频消融治疗 Ⅰ型心房扑动 起搏 传导时间 心律 

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