射频消融治疗室上性心动过速422例的临床评价  

Clinical Evaluation of Radiofrequency Ablation Therapy for 422 Cases with Supraventricular Tachycardia

作　　者：唐烨晖[1] 申强[1] 孙秀才[1] 艾庆[1] 

机构地区：[1]湖南省怀化市第一人民医院心内科,湖南怀化418000

出　　处：《医学临床研究》2008年第12期2211-2213,共3页Journal of Clinical Research

摘　　要：【目的】研究射频导管消融术(RFCA)对室上性心动过速的疗效及方法学。【方法】对422例室上性心动过速患者行RFCA。旁路采用在心室最早激动点(EVA)或心房最早激动点(EAA)消融,双径路则采用消融慢径。统计其首次成功率、复发率、并发症发生率,并比较RFCA初期与近6年的有关指标。【结果】①422例患者中.旁路190例、房室结双径路合并左侧旁路2例,房室结双径路230例,首次成功率为96.68%。②旁路消融3例复发,慢径改良消融中7例复发,但二次消融(包括第一次未成功的)均获成功。③并发症:股动脉血肿13例,股静脉栓塞3例,心包填塞2例,血管迷走反射2例,一过性Ⅲ度房室传导阻滞诱发心室纤颤1例,永久性Ⅲ度房室传导阻滞1例,无死亡病例。④近期6年与开始时6年相比,每例患者的手术时间明显缩短,X线照射时间减少,复发率降低,并发症发生率降低,成功率进一步提高。【结论】①EAA、EVA标测是旁路消融成功关键。慢径消融成功的标准应以电生理检查结果为准。②RFCA根治室上性心动过速安全、有效、复发率低、并发症少,随着治疗病例增多,技术水平可明显提高。[Objective] To study the therapeutic effect and method of radiofrequency ablation（RFCA） for supraventricular tachycardia（SVT）. [Methods] A total of 422 cases with SVT were treated by RFCA. RFCA for SVT patients with accessory pat hway（AP） was performed in the earliest ventricular action （EVA） or the earliest atrial action（EAA）. The slow pathway（SP） ablation of RFCA therapy was performed in SVT patients with double pathway（DP）. The first success rate,the recurrence rate and the rate of complications were added up, and the results of relevant indicators in early stage and late stage during 6 years were compared. [Results] （1）The success rate was 96. 68% in 422 patients（ 190 AP, 230 DP, 2 DP complicated with AP） receiving the RFCA therapy. （2）Tachycardia recurred in 3 cases of AP and 7 cases of SP ablation,which were cured by re-ablation. （3）The complications including 13 femoral artery hematoma, 3 femoral vein thrombosis, 2 cardiac tam- ponade,2 vasovagal reflex, 1 transient Ⅲ. atriovcntricular blockqnduced ventricular fibrillation and 1 permanent Ⅲ. atrioventricular block occurred. No one died. （4） At the late stage, the mean procedure and X-ray ex posure time were significantly shorter than those at early stage. The success rate increased significantly,and the reduction in the recurrence rate and complications was obvious. [Conclusion] （1）The mapping of EAA and EVA are the key methods to the success of AP ablation. The success standard of the SP ablation of RFCA therapy should be based on the results of the cardiac electrophysiologieal tests. （2） RFCA is a safe and effective method for patients with tachyarrhythmia,and has lower recurrence rate and fewer complications. With the in crement of the number of cases, the technical level can be increased significantly.

关 键 词：心动过速 室上性/治疗 导管消融术 

分 类 号：R541.71[医药卫生—心血管疾病]