多种X线投射位结合导管射频消融治疗房室结内折返性心动过速  

Radiofrequency current catheter ablation combined with multiple X-ray projecting angles in the treatment of atrioventricular nodal reentrant tachycardia patients

作　　者：徐云[1] 施林生[1] 黄建飞[1] 李锋 

机构地区：[1]南通大学第二附属医院心脏内科,226001 [2]新疆维吾尔自治区伊犁哈萨克自治州友谊医院心脏介入科

出　　处：《中国医师进修杂志》2010年第31期17-19,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 总结多种X线投射位结合导管射频消融治疗房室结内折返性心动过速（AVNRT）的效果及对并发症的预防.方法 206例AVNRT患者分别于后前位（PA）、右前斜30°（RAO 30°）和左前斜45°（LAO45°）X线投射位下,测量希氏束（His）至冠状窦（CS）口连线距离,选择距离最大投射位开始标测确定靶点,放电前再次于另外两种X线投射位下确认消融电极与His的距离.结果 于PA、RAO 30°和LAO 45°X线投射位下显示最大His至CS口连线距离的病例数分别为66、75、65例（P＞0.05）,距离分别为（2.94±0.87）、（2.98±0.76）和（2.91±0.52）cm（P＞0.05）.经三种不同X线投射位确认,靶点均位于His至CS口连线中点水平以上患者22例,其余患者184例,两者于放电过程中出现一过性第一度或第二度房室传导阻滞例数分别为4例和1例,差异有统计学意义（P＜0.01）.所有患者射频消融治疗均获得成功,未发生永久性房室传导阻滞.结论 采用多种X线投射位相结合的方法,并且熟练掌握不同X线投射位下的消融电极操作特点,有助于提高导管射频消融治疗AVNRT的手术成功率和预防消融并发症.Objective To investigate the therapy efficiency and complication prevention in patients undergoing radiofrequency current catheter ablation combined with multiple X-ray projecting angles.Methods Two hundred and six atrioventricular nodal reentrant tachycardia （AVNRT） patients were involved in this study. The distance between the tip of His and the ostium of coronary sinus were measured under different X-ray projecting angles respectively, including posterior anterior （PA）, right anterior oblique 30° （RAO 30° ） and left anterior oblique 45° （LAO 45° ） in each patient, and mapping was proceeding under the corresponding X-ray projecting angles with the longest distance. The distance between ablating catheter and His was confirmed again before powering by the other two X-ray projecting angles. Results The longest distance between the tip of His and the ostium of coronary sinus were obtained in 66,75 and 65 patients under PA,RAO 30° and LAO 45° respectively（P〉 0.05 ）,and the data were （2.94 ± 0.87）, （2.98 ± 0.76）and （2.91 ± 0.52） cm（P〉 0.05）. Transient first or second degree of atrioventricular blocking was observed in 4 cases among 22 high risk patients in which the powering sites were above the medium level of the distance between the tip of His and the ostium of coronary sinus under three kinds of X-ray projecting angles obviously.However,only 1 case was observed in other 184 patients（P〈 0.01 ）. All patients were cured successfully and no permanent atrioventricular blocking occurred. Conclusion Radiofrequency current catheter ablation combined with multiple X-ray projecting angles is helpful to increasing the successful rate and preventing complication in ablating therapy.

关 键 词：心动过速 房室结折返性 导管消融术 X线投射位 

分 类 号：R541.7[医药卫生—心血管疾病]