射频消融慢径治疗程控不能诱发且没有跳跃的房室结折返性心动过速  

Radiofrequency catheter ablation of slow pathway in patients with dual atrioventricular node pathway and a documented but without inducible tachycardia and with smooth atrioventricular nodal function curves

作　　者：李穗吉[1] 蒋廷波[1] 蒋文平[1] 

机构地区：[1]苏州大学附属第一医院心内科,江苏苏州215006

出　　处：《临床心血管病杂志》2008年第3期172-175,共4页Journal of Clinical Cardiology

摘　　要：目的:评价射频消融慢径治疗程控不能诱发且没有跳跃的房室结折返性心动过速(AVNRT)患者的远期疗效,探讨其电生理机制。方法:临床证实的AVNRT患者101例,在电生理检查中18例程控不能诱发及没有跳跃(A组),19例程控不能诱发(B组),33例程控没有跳跃(C组),31例程控有跳跃并且能诱发(D组)。比较各组电生理的情况及射频消融治疗的远期疗效。结果:术后随访(49.13±30.13)个月,C组1例于术后2个月复发,发生Ⅲ度房室传导阻滞而安装起搏器,D组1例于手术后7个月复发,A、B、C、D组的未复发率均差异无统计学意义(P>0.05)。A、B组与C、D组相比快径逆传功能相对较差,术前B组的快慢径不应期差值较D组小,各组有效消融后交界心律的发生率差异无统计学意义。结论:慢径消融在治疗程控不能诱发及没有跳跃的AVNRT患者是安全有效的。交界性心律可以作为该类患者的射频消融的参考终点。Objective：To assess the long-term efficacy of radiofrequency catheter ablation of slow pathway in patients with dual atrioventricular node pathway （DAVNP） and documented but without inducible tachycardia and with smooth atrioventricular nodal function curves . To study it ＇ s mechanisms . Method ： One hundred and one patients with clinically documented AVNRT underwent successful radiofrequency ablation （RFCA） were included. Patients were divided into four groups. 18 patients who had DAVNP but without inducible tachycardia and with smooth atrioventricular nodal function curves are group A： 19 patients without inducible AVNRT and without smooth atrioventricular nodal function curves are group B; 33 patients with inducible AVNRT but with smooth at- rioventricular nodal function curves are group C： 31 patients with inducible AVNRT but without smooth atrioventricular nodal function curves are group D. To compare the clinical and electrophysiological characteristics among group A, B, C and D. Result：During （49.13±30.13） months follow-up, none of the 37 patients of group A and B had recurrence of PSVT. However,1 patient of the group C had recurrence of PSVT in 2 months after slow-path- way catheter ablation, and 1 patient of the group D had recurrence of PSVT in 7 months after ablation. There is no significant difference of the recurrence ratio among the four groups （P〉0.05）. Compare with the groups C and D, group A and B have relatively poor retrograde fast -pathway conduction. There is no significant difference of the occurrence ratio of junctional rhythm or tachycardia in four groups. There is 1 patient of group C attacked with Ⅲ AVB who implanted pacemaker after catheter ablation. Conclusion： Slow-pathway catheter ablation with radio frequency is safe and highly effective in eliminating PSVT in which the tachycardia is not inducible and with smooth atrioventricular nodal function curves. The occurrence of junctional rhythm or tachycardia could be taken as the end ooint of the cathe

关 键 词：房室结折返性心动过速 导管消融术 

分 类 号：R541.7[医药卫生—心血管疾病]