射频消融治疗快速型心律失常951例临床分析  

Analysis on the clinical outcome of 951 cases of tachycardias who underwent radiofrequency catheter ablation

作　　者：杨成明[1] 王旭开[1] 王红勇[1] 刘光耀[1] 邱金玉[1] 傅春江[1] 方玉强[1] 石伟彬[1] 张晔[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所心内科,重庆400042

出　　处：《重庆医学》2006年第13期1197-1199,共3页Chongqing medicine

摘　　要：目的分析总结经导管射频消融治疗快速型心律失常的疗效,以进一步指导相关临床工作。方法回顾性分析951例(男532例,女419例)经导管射频消融治疗快速型心律失常患者的治疗结果,患者年龄6~78(42.5±14.6)岁,心动过速发作史1个月~42年,采用常规方法进行电生理检查和射频消融。结果房室折返性心动过速(AVRT)569例,计有旁道578条,其中左侧旁道患者462例(分布位置:左游离壁364例,左前壁41例,左后侧壁57例),右侧旁道79例,双旁道9例(右侧6例,左侧3例),房室结双径路合并房室旁道19例(右侧5例,左侧14例)。房室结折返性心动过速(AVNRT)341例,其中260例存在前向跳跃式传导,16例存在逆向跳跃式传导,65例无跳跃式传导。室性心动过速(VT)19例,房性心动过速(AT)22例。射频消融总成功率为97.9%,其中房室结双径路和左侧房室旁道介导的阵发性室上速射频消融成功率高达99.5%。射频消融术后复发率为1.7%。8例术中出现一过性房室传导阻滞,后有2例发生Ⅰ度房室传导阻滞,1例交替出现Ⅰ、Ⅱ、Ⅲ度房室传导阻滞,1例发生Ⅲ度房室传导阻滞后置入永久性心脏起搏器;术后12例发生假性动脉瘤,1例气胸和1例心包填塞。结论经导管射频消融是治疗快速型心律失常安全有效的方法,尤以AVRT和AVNRT的效果最佳。Objective To analyze the clinical outcome of tachycardias who underwent radiofrequency catheter ablation and to provide guidelines for further clinical work. Methods The clinical outcomes of 951 cases of tachycardias who had undergone radiofrequency catheter ablation were retrospectively analyzed. The patient population compromised 532 men and 419 women aged six to seventy-eight （42.5 ± 14.6） years and the history of tachycardia was one month to forty-two years. Normal methods were adopted to carry out electrophyslological test and radiofrequency catheter ablation. Results There were 569 cases of atrioventricular reen trant tachycardias （AVRT） with 578 accessory pathways, including 462 left accessory pathways （364 left free-wall, 41 left anterior and 57 left posterior accessory pathways）, 79 right accessory pathways, 9 double accessory pathways , and 19 accessory pathways concomitant with dual atr^oventricular nodes. There were 341 cases of atrioventricular nodal reentrant tachycardia （AVNRT）, in cluding 260 cases of anterogradely jumping conduction, 16 cases of retrogradely jumping conduction,and 65 cases without jumping conduction. In addition , there were 19 cases of ventricular tachycardia （VT） , 22 cases of atrial tachycardia （AT）. The overall success rate was 97.9 percent, in which radiofrequency catheter ablation of supraventricular tachycards mediated by dual atrioven- tricular nodes and left sided accessory pathway had an high success rate （ 99.5 percent）. The recurrence rate was 1.7 percent after radiofrequency catheter ablation. In 8 cases, contemporary atrioventricular block （AVB） took place during procedure, 2 cases had first-degree AVB, one patient had first-degree AVB and second-degree AVB or complete atrioventricular block, 1 case had corn plete atrioventricular block necessitating pacemaker implantation. Twelve cases had false aneurysm, 1 case had pneumothorax and one patient had pericardial tamponade. Conclusion Radiofrequency catheter ablation can be performed e

关 键 词：一心动过速 导管消融术 并发症 

分 类 号：R541.7[医药卫生—心血管疾病]