房性心动过速电生理机制、标测和射频消融方法的临床研究  

Electrophysiologic characteristics and mapping of the site of origin and the results of radiofrequency ablation for atrial tachycardia

作　　者：吴书林[1] 李海杰[1] 杨平珍[1] 陈泗林[1] 詹贤章[1] 方咸宏[1] 欧阳非凡[1] 郑祥生[1] 钱卫民[1] 林纯莹[1] 

机构地区：[1]广东省心血管病研究所心内科,广州510100

出　　处：《中华心律失常学杂志》2000年第2期108-111,共4页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的　探讨房性心动过速 (房速 )的电生理学机制、靶点标测和射频消融治疗结果。　方法　 44例房速患者行心内电生理检查和射频消融术 ,房速靶点标测采用激动标测方法 ,4例用非 X线心脏磁电解剖学标测系统 (CARTO系统 )标测和指导消融。右心房用两根大头消融导管交替移动标测寻找靶点 ,采用预设 6 0～ 6 5℃温控放电消融。　结果　经电生理检查证实 44例房速中 11例为自律性房速 ,33例为非自律性房速。 40例 (91% )射频消融即刻成功 ,40例有 43个房速病灶位 ,其分布为房间隔 2 1个 ,右房侧壁 18个 ,希氏束旁 (Koch三角尖 ) 3个 ,左房 1个。 4例合并房室结折返性心动过速 ,经改良房室结成功 ,4例合并心房扑动划线消融成功。有 1例希氏束旁房速术后出现三度房室阻滞。　结论　房速射频消融成功率较高 ,其病灶部位以房间隔和右心房侧壁为多见 ,希氏束旁房速消融应注意防止出现房室阻滞并发症。 CARTO系统对房速的标测有一定帮助。Objective To investigate electrophysiologic characteristics and the original site of atrial tachycardia (AT) and the results of radiofrequency ablation (RFA). Methods Electrophysiologic study and RFA were performed in 44 patients with AT.The site of origin of AT was mapped by using activation mapping during tachycardia and with two large tipped catheters.Magnetic electroanatomical mapping (CARTO system) for ablation of atrial tachycardia was performed in 4 patients.The method of preselecting a temperature of 60～65℃ was selected for ablation. Results In 44 patients,electrophysiologic study showed that the mechanism of ATs was automatic (11 patients) and nonautomatic (33 patients).ATs were successfully ablated in 40 patients (91%).43 foci in 40 patients with AT were seperately located in interauricular septum (21 foci),lateral area of right atrium (18 foci),para His bundle area (near the apex of Koch's triangle,3 foci) and left atrium (1 focus).RFA was successful in 4 patients with atrioventricular node reentrant tachycardia combining with AT.Linear ablation was successful in 4 patients with atrial flutter combining with AT.One patient with AT originated from para His bundle area was complicated by complete atrioventricular block (AVB) after RFA. Conclusion The success rate of RFA in AT of the atrium was high.The foci were mainly located in interauricular septum and lateral area of right atrium.In patients with AT originated from para His bundle area special atlention has to be paid during ablation procedure for the purpose of preventing the atrioventricular block complication.It is helpful to map the site of origin of AT with CARTO system.

关 键 词：房性心动过速 电生理学 射频消融术 

分 类 号：R541.7[医药卫生—心血管疾病]