慢径消融时出现交界区心律伴室房逆传阻滞意义的再探讨  

Reinvestigation of the significance of junctional rhythm with ventriculoatrial block appearing during radiofrequency ablation of the slow pathway

作　　者：韩冰[1] 曾秋堂[2] 张毅刚[1] 吴浩[3] 杨金刚 彭城[3] 李岩松 

机构地区：[1]徐州市中心医院心内科,江苏徐州221009 [2]华中科技大学同济医学院附属协和医院 [3]徐州医学院第二附属医院 [4]徐州市第三医院

出　　处：《中国心脏起搏与心电生理杂志》2008年第6期518-520,共3页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的探讨慢径消融过程中出现交界区心律伴室房逆传阻滞的意义。方法房室结折返性心动过速经射频消融治疗患者,共91例。采用由低至高的逐点递进的方法进行消融,放电中注意观察交界区心律伴逆传阻滞现象的出现。结果所有病例均获得手术成功,其中3例首次消融后复发。91例手术中有47例曾出现交界区心律伴逆传阻滞,与无逆传阻滞组相比较,手术时间及曝光时间无明显差异,但放电次数多于后者;在共计309次有效放电中,95次有室房逆传阻滞,与214次无逆传阻滞者相比较,其靶点与His束电极间垂直距离明显小于后者,伴发一过性房室传导阻滞(AVB)的比例亦明显大于后者(12.63%vs 2.39%),多元Logistic回归分析发现靶点到HBE电极间垂直距离≤1.5 cm是房室前传阻滞的独立相关因素(OR=12.50,P=0.018),而交界区心律伴逆传阻滞与AVB间相关性不明确(P>0.05)。结论在消融慢径的过程中,出现交界区心律伴逆传阻滞与房室前向传导阻滞之间并无明确的相关性,而消融靶点过高则是出现AVB的独立危险因素。Objective To investigate the significance of junctional rhythm with ventriculoatrial block appearing during radlaofrequency ablation of the slow pathway. Methods Ninety-one patients who had been performed the operation of radiofrequeney catheter ablation for atrioventricular reentrant tachycardia （AVNRT） were included in this study. The ablation catheter was moved high stepwise until the endpoint had been attained. Special attention was paid to the phenomenon of junctional rhythm with ventrieuloatrial block appearing with discharging radiofrequency energy. Results All eases had undergone successful procedures. Tachycardla recurred after the first procedure in 3 patients. Junctional rhythm with ventriculoatrial block was observed during procedures in 47 cases. Comparing with those cases without ventriculoatrial block, procedure duration and fluoroscopy time were not significantly different, but more applications were needed. Of the total 309 effective applications, there were 95 with ventriculoatrial block （A group） and 214 without （B group） it, respectively. The perpendicular distance between the target site and the His bundle catheter was significantly shorter and the percentage of temporal atrioventricular block （AVB） was significantly larger in A group than that in B group（ 12.63% vs 2.39% ）. However, Logistic regression analysis revealed that the perpendieular distance between the target site and HBE not larger than 1.5 cm was the only significant predictor of AVB （ OR = 12. 50,P = 0.018） and the correlation between junctional rhythm with ventriculoatrial block and AVB was uncertain （ P 〉 0.05 ）. Conclusion During the procedure of ablating slow pathway, the appearance of junctional rhythm with ventriculoatrial block is uncertainly associated with AVB. On the contrary, performing ablation at a too much high target site is just the independent predictor.

关 键 词：电生理学 房室结双径路 导管消融 射频电流 交界区心律 室房逆传阻滞 

分 类 号：R331.38[医药卫生—人体生理学] R451.7[医药卫生—基础医学]