射频消蚀房室结慢径过程中房室传导阻滞的预防  

Prevention of atrioventricular block during radiofrequency ablation of slow pathway in atrioventricular node reentrant tachycardia

作　　者：黄德嘉[1] 姜建[1] 文山[1] 尹秋熙[1] 

机构地区：[1]华西医科大学第一附属医院心内科

出　　处：《中华心血管病杂志》1995年第2期124-126,共3页Chinese Journal of Cardiology

摘　　要：在选择性射频消蚀房室结慢径过程中，完全性房室传导阻滞仍为严重并发症。我们从小功率（１０Ｗ）放电开始，根据放电时的反应，逐步增大放电功率或改换较为安全的放电部位。本组６５例病人，６４例消蚀慢径成功，无１例遗留房室传导阻滞的并发症。最大放电功率１８±３．８Ｗ，中位数１５Ｗ。消蚀慢径成功部位分布在从希氏束下方到冠状窦口附近这一相对较大的区域内。Abstract Complete atrioventricular (AV) block is still a serious complication during radiofrequency ablation of the slow pathway in AV node reentrant tachycardia (AVNRT). The purpose of this study was to decrease the risk of AV block by titrating power output in the procedure. Sixty-five patients with AVNRT underwent selective ablation of the slow pathway. In Koch's triangle ,from regions inferior to His bundle to the coronary sinus, anatomically guided approach was used to define the ablation site. Radiofrequency was initially applied at 10 watts for 10-15 seconds. If no junctional ectopy or change of PR interval was seen , power output was increased to 15 watts. When junctional rhythm occurred ,its characteristics, such as fast frequency of junctional rhythm (≥ 150 beats/min), AV dissociation and prolongation of PR interval, were used to judge wether the ablation site was safe or not. If it was safe and without junctional techycardia heralding AV block, the power output was increased to 18, 20, 25 , and 30 watts successively until the junctional beats decreased remarkably.In 64 (98 % ) patients , the slow pathway was successfully ablated without injury of the fast pathway.Maximum power output was 18± 3. 8 watts and the median was 15 watts. No AV block occurred after the procedure and during the follow up. In conclusion, starting at low power and gradually increasing the output according to the response during radiofrequency ablation of the slow pathway could reduce the risk of AV block.

关 键 词：射频消融术 心动过速 房室 传导阻滞 预防 

分 类 号：R541.710.5[医药卫生—心血管疾病]