左侧房室旁道导管射频消融术的方法学探讨  

The Methodology of Radiofrequency Catheter Ablation on Left-sided Atrioventricular Accessory Pathway

作　　者：卢才义[1] 郗晓红[1] 刘宣力[1] 田赫华[1] 王文清[1] 黄丛春[1] 毛树森[1] 江一清[1] 

机构地区：[1]空军总医院心律失常研究中心,100036

出　　处：《中国介入心脏病学杂志》1993年第2期13-17,49,共6页Chinese Journal of Interventional Cardiology

摘　　要：采用粗标冠状窦、细标房室环的方法对10例左侧旁道参与的室上性心动过速病人进行导管射频消融治疗.通过对消融电极与冠状窦标测电极相对位置的比较,对消融能量选择、心内电图参数等问题的分析,结果发现:①冠状窦标测电极与射频消融电极的相对位置相差达21.3±5.3mm(10～40mm);②在不同的病人,按经验选择的15W、20W和30W能量均能 消融成功;③消融过程中阻抗突然大幅度增加除反映消融部位心内膜组织焦痂形成外,还常常提示能量选择偏高;④在心室起搏、窦性预激和心动过速下标测放电均可打断旁道,但以心动过速中消融的效率最高;⑤在心室起搏和心动过速中消融时.除了要注意室房传导时间(VA)这一参数外,还应强调有适当的V/A幅度比;在窦性预激下消融时,尤其要注意标测到最短的AV和V波比体表DeLta波提前.因此,作者认为:①为了提高消融效率,减少无效消融次数和对心内膜的损伤,应重新考虑在冠状窦对旁道进行准确的标测定位;②在找到有效的能量选择方法以前,建议采用温敏消融导管,以便以最小有效消融能量进行消融;③在没有温度监测的情况下,监测消融电极阻抗有利于调整所选择的消融能量;④与心室起搏和窦性预激下标测相比,心动过速中的标测结果具有更高的准确性和实用性;⑤术中对消融电极心内膜标测电图多项参数的?Ten patients with left-sided atrioventricular accesso-ry pathway refractory atrioventricular reentrant tachy-cardia were treated with radiofrequency catheter abla-tion , By comparing the relative positions of ablation elec-trode and coronary sinus target electrode, analysing the selection of radiofrequency energy and the parameters of mapping electrogram etc. we found that: (1) there was a distance of 21,3±5. 33mm between the ablation elec-trode and the coronary sinus target electrode; (2) the en-ergy of 15W,20W and 30W selected on experience were the same effective; (3)the abrupt and 30W selected n ex-perience were the same effecive; (3 ) the abrupt and large scale of increase in impedance suggested that scar on ab-lation electrode surface occured and the excessive ablation energy was used; (4 ) the ideal mapping results during tachycardia, ventricular pacing and preexcited sinus beat were all suitable for ablation, but the ablations during tachycardia were most effective; (5 ) the ventriculoatrial conduction time and the ratio of V wave and A wave when ablation in ventricular pacing and the ventriculoa-trial conduction time when ablation in tachycardia were all important for the sucessful ablation. Therefore, we suggest that: (l)accurate coronary sinus mapping should be considered in order to reduce uneffective ablations; (2)before the method of effective ablation energy selec-tion is defined, the temperature mornitoring catheter is better to be used to get maxmum effect with minimun ab-lation energy; (3) as well as temperature monitoring, the ablation impedance monitoring is also benificial to the se-lection of ablation energy; (4) compared with mapping during ventricular pacing and sinus preexcitation, the mapping results during tachycardia are more accurate and practical; (5)the real measurement of multiparameters of mapping electrograms during ablation procedures is very important for successful and effective ablation.

关 键 词：左侧房室旁道 射频导管消融 

分 类 号：R541[医药卫生—心血管疾病]