房室结改良的心内电图研究  

Research of intracardiac electrography in modificating atrioventricular node

作　　者：王瑞生[1] 于世龙[1] 丁枭伟 曾秋棠[1] 李景东[1] 陈志坚[1] 张家明[1] 

机构地区：[1]同济医科大学心血管病研究所

出　　处：《临床心血管病杂志》1999年第12期558-560,共3页Journal of Clinical Cardiology

摘　　要：目的：探讨射频电消融（RFCA）术改良房室结治疗房室结折返性心动过速（AVNRT）心内电图特点，以指导其治疗。方法：采用下位法阻断慢通道改良房室结对52例AVNRT患者RFCA消融靶点进行研究。结果：在影像学上，左前斜位有效靶点位于右房室环2～5点之间，其中3点处占58.6％。从临床电生理上分析，有效靶点是小A波、大V波，A波碎裂或有慢电位。慢电位在A波后、希氏束电位前，通常间期短、振幅低。当记录到碎裂心房电位及侵电位，且A／V＜0．25处进行放电消融时，可以减少放电次数和X线照射时间。结论：慢电位及碎裂心房电位作为指导消融的心内电图指标，能提高RFCA术效率。Objective:The fluoroscopic and intracardiac electrographic characters of 52 patientswere researched in order to guide radiofrequency catheter ablation (RFCA) procedure and preventcomplication. Metbod:Method of modificating the slow pathway of atrioventricular node by RFCAwas used.Result:①By fluoroscopic screen in left anterior oblique view,the ablation target was lo-cated in tricuspid annulus,between two to five o'clock,among them, 58. 6 % in three O'clock. ②Theintracardiac electrographic characters of effective target of ablation were small fractional A waveand large V wave with slow potential. ③Slow potential (SP) could be recorded in 46.2% patients,and it is located be fore His bundle potential. A-SP duration was (46.l±13.3) ms. It is a wave oflow amplitude and short duration. ④The character of intracardiac ECG in target point is fractionalA wave/slow potential and A/V ＜ 0. 25, thus, it could reduce X ray'S radiation time and ablationtimes. Conclusion:①In fluoroscopic screen,the ablation target is located in tricuspid annulus be-tween two to five O'clock in left anterior oblique view. The most common site is located on threeo'clock. ②The site of small amplitude A wave and large amplitude V wave (A/V＜0. 25) withfractional A wave or slow potential is the effective ablation target. ③RFCA is a safe and effectivemethod for curing AVNRT.

关 键 词：导管消融术 心动过速 房室结折返性 心电图 

分 类 号：R541.710.4[医药卫生—心血管疾病] R540.41[医药卫生—内科学]