射频导管消融改良房室结慢径路的方法学评价  

Evaluation of slow pathway of dual atrioventricular nodal pathways by catheter radiofrequency ablation modification method

作　　者：卢才义[1] 刘宣力[1] 郗晓红[1] 黄从春[1] 魏璇[1] 王文清[1] 毛树森[1] 

机构地区：[1]空军总医院心律失常研究中心,100036

出　　处：《心电学杂志》1997年第4期198-199,共2页Journal of Electrocardiology(China)

摘　　要：为评价射频导管消融改良房室结慢径路的两种方法,对连续42例房室结内折返性心动过速患者分别采用下位法和后位法进行慢径路改良。结果总成功率97.6％,并发症率2.4％。认为;(1)下位法比后位法明显有效,但发生完全性心脏传导阻滞的危险性亦增加;(2)建议对年轻者(如≤55岁)优先采用后位法,对年长者可径用下位法,必要时可在消融电极心电图上保留较小的希氏束电位放电;(3)采用下位法时必须先以消融电极稳定记录到明确的希氏束电位后,再向下弯曲导管,以提高定位慢径路的准确性和减少心脏传导阻滞的发生;(4)放电中出现与窦性心律竞争的房室交接区性心律现象揭示消融有效,而出现房室交接区性心动过速则提示可能发生完全性传导阻滞。Two catheter radiofrequency oblation modification methods were employed to evaluate dual atrioven-tricular nodal pathways. Inferior and posterior modification approaches were used separately to ablate slow pathways of 42 patients with atrioventricular nodal reentrant tachycardia. Success and complication rates were 97. 6% and 2. 4% respectively. Authors have concluded that: (1) Inferior approach is more effective yet with higher risk than posterior approach. (2) Younger patients (≤54Ys) could be ablated by posterior approach at first followed by inferior approach if it is not successful; older patient (>55Ys) could be ablated directly by inferior approach and more minuat His potential preserved in ablation electrode electrogram is suggested if necessary. (3) When inferior approach is used, a clear and stable His potential should be recorded by ablation electrode first so as to confirm that His bundle is already kept away and to locate compact node accurately. (4) Phenomena of junction rhythm andtachycardia during ablation usually indicate respectively successful modification and possibly complete heart block.

关 键 词：心动过速 AVNPT 射频消融 方法学 

分 类 号：R541.710.5[医药卫生—心血管疾病]