射频消融治疗阵发性室上性心动过速262例分析  

Analysis of 262 patients with paroxysmal supraventricular tachycardia treated by radiofrequency ablation

作　　者：夏雷[1] 王和平[1] 俞志刚[1] 丁坤[1] 史玉露[1] 

机构地区：[1]安徽省蚌埠市第二人民医院,安徽蚌埠233000

出　　处：《河北医学》2000年第6期495-498,共4页Hebei Medicine

摘　　要：目的 :经导管射频消融 (RFCA)治疗阵发性室上性心动过速 (PSVT) 2 6 2例 ,探讨RFCA治疗 PSVT的安全性及疗效。方法 :房室结双径路改良采用下位法 ;左侧旁道采用冠状窦电极粗标 ,大头电极在心室侧细标。右侧旁道采用左前斜 4 5度 ,大头电极在心房侧三尖瓣环处细标 ;房扑时标测心房激动顺序 ,用隐匿性拖带法确定折返环部位 ,在心房内行线性消融方法治疗。结果 :2 6 2例中慢—快型房室结折返性心动过速 (AVNRT) 78例 ,房室折返性心动过速 (AVRT) 158例 ,心房扑动2 6例。首次消融成功率 10 0 %。2例于手术后 d2、d3出现轻度气胸 ,3例 AVNRT在放电时出现一过性 度房室传导阻滞外 ,其余术中、术后均无并发症发生。术后随访 16± 4个月 ,8例 AVNRT复发(10 .0 3% ) ,4例房扑复发 (15.4 0 % ) ,总复发率 2 1.80 %。结论 :1RFCA治疗 PSVT安全、有效。 2旁道定位的准确性及导管操作技巧是消融成功的关键。Objective:[WT5BZ]To discuss the security and efficacy of radiofrequency catheter ablation (RFCA) treating paroxysmal supraventricular tachycardia(PSVT).[WT5HZ]Methods:[WT5BZ]Hypogynous technique was used to improve dual AV nodal pathway.To left accessory pathway(AP),we use coronary sinus electrode rough AP mapping and big head electrode precious mapping at the ventricle side Right AP was precious Apmapped at tricuspid ring on the atrium side with big head electrode at left anterior inclined 45 degree.The atrial flutter(AF) reentrant circuits were mapped by atrial activation sequence and cancelled entrainment.AF was treated by linear RF ablation [WT5HZ]Result:[WT5BZ]78 of 262 cases were slow fast atrioventricular nodal reentrant tachycardia(AVNRT),158 cases were atrioventricular reentrant tachycardia(AVRT) and 26 cases were AF.All of the cases were successfully ablated.Pneumothorax occurred in 2 cases after procedure 2 or 3 days.3 cases appeared perfectibility atrioventricular block when the energy was delivering.The others have no complication.During the follow up of 16±4 months there were 8 cases of AVNRT(10.03%) and 4 cases of AF(15.40%)recurrence.The total recurrence rate was 21.80%.[WT5HZ]Conclusion:[WT5BZ]①RFCA is a safe and effective procedure for patients with PSVT.②The main factors determining the success rate of ablation are finding the veracious position of the accessory pathways and operating the catheter skillfully.③AF reentrant circuits can be found by atrial actibation and cancelled entrainment. [WT5HZ]

关 键 词：室上性心动过速 射频消融术 疗效 

分 类 号：R541.7[医药卫生—心血管疾病]