射频消融术后复发原因分析  

The clinical analysis of recurrence cause after radiofrequency catheter ablation

作　　者：程应樟[1] 程晓曙[1] 吴清华[1] 吴延庆[1] 李菊香[1] 饶芳[1] 童金英 苏海[1] 

机构地区：[1]江西医学院第二附属医院心内科,南昌330006 [2]江西鹰潭市人民医院,进修生江西鹰潭300000

出　　处：《岭南心血管病杂志》2005年第5期331-333,共3页South China Journal of Cardiovascular Diseases

摘　　要：目的了解射频消融治疗各种心律失常复发原因。方法通过l108例射频消融治疗病例进行回顾性总结,对其中40例复发患者从诊断、消融部位、靶点图形、功率、即刻成功时间和术中是否诱发心动过速及术后心电生理情况以及消融技术开展时间等方面进行临床分析,总结复发原因。结果①总复发率为3.7%,其中房室折返性心动过速3.1%,房室结折返性心动过速2.6%;②对诊断复杂,右侧旁道,靶点V-Q间期小于10ms,消融功率大于25W,即刻成功长于5秒,消融时AV波稳定性差及术中未诱发心动过速的房室折返性心动过速患者容易复发(P<0.01);③对消融功率大于30W才出现结性心律,术中未诱发心动过速及术后仍存在心房回波和A-H跳跃现象的房室结折返性心动过速也容易复发(P﹤0.01);④对V-Q间期短于20ms的室性期前收缩也易复发;⑤复发病例多集中在消融技术开展的第2～5年。结论诊断是否明确,对消融靶点的掌握,消融部位及功率的选择,即刻成功时间,术中是否诱发心动过速及消融技术开展时间是引起射频消融治疗心律失常复发的主要原因。Objectives To analyze recurrence cause of various kinds arrhythmia after radiofrequency catheter ablation（RFCA）. Methods 1108 cases treated with RFCA were reviewed retrospectively. The recurrence causes were investigated in 40 recurrent patients from the diagnosis, ablation sites, figure of target sites, power, immediate success time, induced tachycardia and information of endocardial electrophysiology during operation, period of technology of ablation develop. Results The recurrence rate in atrioventricular reentry tachycardia was 3.1%, that in atrioventricular node reentry tachycardia was 2.6%, total was 3.7%. Patients, in which diagnosis was difficult to ensure, right accessory pathway existed,V-Q interval in target sites was less than 10 ms, ablation power was more than 25 W, immediate success time was more than 5 s, AV waves was unstable and taehyeardia was not induced in atrioventrieular reentry taehyeardia, were easy to recur （P 〈 0.01 ）. Other elements easy to recur includes that nodal rhythm appeared not until that ablation power was increased up more than 30W, tachycardia was not induced during operation, and atrium echo still existed after operation and A-H leaping in atrioventricular node reentry tachycardia, premature ventricular beats with V-Q interval of less than 20 ms. Most recurrences happened in 2-5 years of technology of ablation develop. Conclusions The main causes of recurrence after RFCA are difficult to ensure the diagnosis, to choose the target sites and instrument power, which was influenced by immediate success time, study in operation to induce tachycardia and skill of operators.

关 键 词：心律失常 射频消融 房室折返性心动过速 房室结折返性心动过速 复发原因 

分 类 号：R541.7[医药卫生—心血管疾病]