快慢型房室结折返性心动过速的电生理机制和经导管射频消融  

The mechanism and radiofrequency catheter ablation of fast/slow atrioventricular nodal reentrant tachycardia

作　　者：王雪[1] 王祖禄[1] 梁延春[1] 梁明[1] 韩雅玲[1] 苗驰[1] 

机构地区：[1]辽宁医学院沈阳军区总医院培训基地心内科,辽宁沈阳110016

出　　处：《中国心脏起搏与心电生理杂志》2010年第1期34-38,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的探讨快慢型房室结折返性心动过速(AVNRT)的电生理机制和经导管射频消融。方法快慢型AVNRT消融患者42例。消融方法为在心室起搏或心动过速时标测最早逆传慢径心房激动部位,然后在窦性心律下或心动过速时消融。消融成功的标准为消除逆传慢径、1:1前传慢径及不能诱发任何类型AVNRT。结果所有42例均消融成功。逆传慢径消融成功部位在三尖瓣环和冠状静脉窦(CS)口之间(传统慢径区域)36例(86%),其最早逆传心房激动也位于上述区域;逆传慢径在CS近端或/和二尖瓣环心房侧消融成功6例(14%),其最早逆传心房激动多位于CS近端1～3cm处。结论多数快慢型AVNRT可在传统慢径区域(房室结右侧后延伸)消融成功,但部分病例需要在CS近端和/或二尖瓣环房侧(左侧后延伸)消融成功。Objective The electrophysiologic mechanism and ablation technique of fast/slow atrioventricular nodal rcentrant tachycardia （AVNRT） have not been well established yet. The purpose of this study is to investigate the results of radiofrequency catheter ablation of fast/slow AVNRT. Methods The study consisted of 42 patients referred for catheter ablation of fast/slow AVNRT. For ablation of fast/slow AVNRT, radiofrequency current was initially directed at the site with earliest retrograde atrial activation during slow pathway conduction. The end points of ablation were that elimination of retrograde slow pathway conduction and 1 ： 1 antegrade slow pathway conduction and unindueibility of any form of AVNRT. Results Radiofrequency ablation eliminated fast/slow AVNRT in all the 42 patients. The earliest retrograde atrial activation during slow pathway conduction and the successful ablation sites for eliminating fast/slow AVNRT were located in the sites between the tricuspid annulus and CS ostium in 36 patients （86%）. The earliest retrograde atrial activation during slow pathway conduction and the successful ablation sites for eliminating fast/slow AVNRT were located within the proximal CS and at the atrial aspect of the proximal mitral annulus in 6 patients （ 14% ）. Conclusions In most fast/slow AVNRT patients, the successful ablation site is between the tricuspid annulus and CS ostium （ right posterior extension of the AV node）, but in some patients the sites might be within the proximal CS or at the atrial aspect of the proximal mitral annulus （ left posterior extension）.

关 键 词：电生理学 房室结折返性心动过速 快慢型 导管消融 射频电流 

分 类 号：R541.71[医药卫生—心血管疾病] R331.38[医药卫生—内科学]