射频消融治疗高龄老年人阵发性室上性心动过速14例  

Radiofrequency catheter ablation in treating paroxysmal supraventricular tachycardia in elderly patients.

作　　者：沈文均[1] 葛世俊[1] 周建庆[1] 柳俊平[1] 周军波[1] 

机构地区：[1]宁波市医疗中心李惠利医院心血管内科,浙江宁波315041

出　　处：《心脏杂志》2006年第3期346-348,共3页Chinese Heart Journal

摘　　要：目的 探讨射频消融（RFCA）治疗老年人室上性心动过速的有效性和安全性。方法采用常规方法射频消融治疗80岁以上阵发性室上性心动过速（PSVT）患者14例，其中慢径消融治疗房室结折返8例、旁路消融5例、线性消融房扑1例。结果80岁以上的高龄老年PSVT患者14（男11，女3）例，年龄80—87（83．7±3．0）岁。主要并发症有高血压病、高脂血症、冠心病、慢性喘息型支气管炎、肺气肿、脑梗死、糖尿病、肥厚性心肌病和主动脉瓣狭窄等。先行冠状动脉造影术4例；髂动脉迂曲，选择对侧动脉或使用长血管鞘跨过迂曲部位消融成功3例；术中发生心衰1例，在导管操作及电生理检查中诱发房颤（AF）2例；主动脉瓣狭窄应用直接穿间隔法后消融1例；在放电时出现Ⅱ度房室传导阻滞1例，放电时出现Ⅰ度房室传导阻滞（PR间期大于0．24s）2例。穿刺点出现血肿1例。14例患者均首次消融均成功，其中2例复发，再次消融成功。术后共随访6—24月，均未复发，也无传导阻滞等严重并发症发生。结论射频消融治疗高龄老年人室上性心动过速是有效、安全的。AIM To evaluate the efficacy and safety of radiofrequency catheter ablation （RFCA） in the treatment of paroxysmal supraventricular tachycardia in 14 elderly patients. METHODS Fourteen patients aged over 80 underwent one of the following catheter ablation procedures ： AV node modification for the treatment of AV node reentrant tachycardia （8 patients）, accessory pathway ablation （5 patients ） or ablation of the slow zone to cure atrial flutter （ 1 patients）. RESULTS Coronary angiography was performed before radiofrequency catheter ablation （RFCA） in 4 cases. RFCA was successful in 3 cases by choosing either the other side of the iliac artery or using a longer catheter due to circuitous iliac artery. During the process of manipulation of catheter and electrophysiologic examination, atrial fibrillation was induced in 2 cases. A patient with aortic stenosis was successfully ablated by puncturing septum directly. One case was found with Ⅱ°AVB and two with Ⅰ° AVB（ PR delay was longer than 0.24 second） during discharge and hematoma was found at the spot where the vessel was punctured in one case. Ablation was successfully performed in all the 14 patients. A 6 -24 month follow-up found no serious complications and recurrence. CONCLUSION Radiofrequency catheter ablation is effective and safe for the treatment of paroxysmal supraventricular tachycardia in elderly patients

关 键 词：老年人 高龄 心动过速 射频消融术 

分 类 号：R541.71[医药卫生—心血管疾病]