经导管射频消融治疗阵发性室上性心动过速1106例临床分析  

Catheter ablation of paroxysmal supraventricular tachycardia：a single-center prospective study of 1106 cases

作　　者：周法光 黄卫斌 陈超 万发银 郭晋村 王焱 洪江[2] 

机构地区：[1]福建省厦门市心脏中心心内科,361002 [2]上海交通大学附属第一人民医院心内科

出　　处：《中国综合临床》2012年第6期600-603,共4页Clinical Medicine of China

基　　金：厦门市科技计划第一批立项项目（3502220074003）

摘　　要：目的探讨经导管射频消融治疗阵发性室上性心动过速的效果及安全性。方法2003年7月至2011年1月在厦门市心脏中心行心内电生理检查及射频消融术治疗的心动过速患者1106例，分析各型心动过速的构成比，评价术中成功率及其相关因素，长期随访观察复发率及并发症发生率。结果共纳入阵发性室上性心动过速患者1106例，男女比例为1：1，其中房室旁道型心动过速588例，房室结折返型心动过速477例，房性心动过速41例。术中即刻消融成功1087例（98．3％，1087／1106），复发43例（3．9％，43／1106），其中房室结折返型心动过速复发7例（1．5％，7／477）；房室旁道复发33例（5．6％，33／588），左侧旁道复发16例（3．9％，16／302），右侧旁道17例（9．1％，17／186）；房性心动过速复发3例（8．1％，3／41）。并发症发生率为1．5％（17／1106），主要为气胸6例，血气胸1例，肺栓塞1例，左颈皮下气肿1例，术中一过性Ⅲ度房室传导阻滞2例，术中I度房室传导阻滞3例，术后持续性Ⅲ度房室传导阻滞需植入永久性心脏起搏器2例（0．2％），术后5d心源性猝死1例，为长期中风卧床者，为手术非相关死亡。结论经导管射频消融为阵发性室上性心动过速安全有效的治疗方法。Objective To investigate the efficacy and safety of catheter radiofrequency ablation of paroxysmal supraventricular tachycardia. Methods From Jul 2003 to Jan 2011,1106 cases with narrow QRS complex tachycardia who were treated by catheter radiofrequency ablation were recruited from our center and followed up for the rates of successful treatment, recurrence and complications. Results There were in total 1106 patients （atrioventricular reentrant tachycardia： 588 ; atrioventricular nodal reentrant tachycardia： 477 ; atrial tachycardia：41） ,with a sex proportion of 1：1. Successful ablation rate was 98. 3% （1087/1106）. Of the 1087 successful ablation cases, 43 （ 3.9% ） were warranted repeated ablation. The recurrent rates for trioventricular nodal reentrant tachycardia, atrioventricular reentrant taehycardia, left accessory pathway and right accessory pathway were 1.5% , 5.6% , 3.9% , and 9. 1% respectively. Complication rate was 1.5% . The major complications included pheumothorax （ 6 cases ）, pulmonary embolism （ 1 case ）, transient third-degree atrioventricular block （ 2 cases ）, first-degree atrioventricular block （ 3 cases ）, and persistent third-degree atrioventricular block（2 cases）with pacemaker implantation. There was one case of cardiogenic sudden death 5 days after the treatment procedure. The eause of his death was chronic stroke-related but not related to the operation procedure. Conclusion Catheter ablation has high efficacy and low complication rate in long-term follow-up, and is a promising treatment for paroxysmal supraventricular tachycardia.

关 键 词：阵发性室上性心动过速 射频消融 电生理检查 

分 类 号：R541.7[医药卫生—心血管疾病]