怀疑AVNRT患者的经验性导管消融  

Empirical Slow-pathway Catheter Ablation for Suspected Atrioventricular Nodal Re-entrant Tachycardia

作　　者：杨曙光[1] 汤学超[1] 张杰[1] 李召峰[1] 陈宁 

机构地区：[1]山东泰安解放军第88医院,271000

出　　处：《临床心电学杂志》2017年第3期199-201,204,共4页Journal of Clinical Electrocardiology

摘　　要：目的探讨经验性慢径导管消融治疗临床疑似房室结折返性心动过速(AVNRT)的可行性。方法回顾分析本院1998年10月~2015年10月368例接受房室结慢径消融治疗患者的临床资料、电生理检查与导管射频消融治疗结果及随访结果,比较323例电生理检查证实存在房室结双径传导且能诱发AVNRT和45例存在房室结双径传导但不能诱发AVNRT患者的消融结果及平均7.8年随访期内心动过速复发率,另对21例疑似AVNRT但电生理检查无房室结双径传导,无可诱发心动过速,且未接受慢径消融治疗的患者进行了平均1.4年随访。结果经导管射频消融术中不能诱发AVNRT患者与术中能诱发心动过速患者首次慢径消融的成功率均为100%,且均无严重并发症发生;术中不能诱发心动过速患者随访期心动过速复发率(4.4%)高于术中能诱发AVNRT患者(1.5%)(p<0.05%)。术中能诱发AVNRT患者消融后复发病例均为首次消融时未达到主要消融终点(A-H间期跳跃现象消失)者,术中未诱发心动过速患者消融后复发病例再次电生理检查时均未发现存在房室结双径传导现象,亦未再诱发心动过速。在平均1.4年随访期内38%的疑似AVNRT但未接受经验性慢径消融治疗的患者再次发生心动过速。结论对于电生理检查证实存在房室结双径传导但不能诱发心动过速的疑似AVNRT患者,经验性慢径导管消融治疗安全有效,但应尽量以A-H间期跳跃现象消失作为消融终点。对于电生理检查未证实存在房室结双径传导,且不能诱发心动过速的疑似AVNRT患者,应酌情选择经验性慢径导管消融治疗。Objective To explore the feasibility of empirical slow-pathway catheter ablation for the treatment of suspected atrioventricular nodal re-entrant tachycardia（AVNRT）. Methods The clinical data, records of electrophysilogical study（EPS） and radio-frequency catheter ablation as well as follow-up data in 368 patients underwent slow-pathway catheter ablation were retrospectively analysed. The ablation results and recurrence rate were compared between 323 patients with inducible AVNRT in EPS and 45 patients without inducible AVNRT. The clinical and follow-up data of 21 patients with suspected AVNRT but without undergoing catheter ablation were also analysed. Results The successful rate was 100% in all patients underwent slow-pathway catheter ablation but the recurrence rate in follow-up periods was higher in patients without inducible AVNRT in EPS than that in patients with inducible AVNRT（4.4% vs 1.5%, p〈0.05）. However, no dual atrioventricular nodal pathway conduction and inducible tachycardia was found in the second EPS in these recurrent patients without inducible AVNRT in the first EPS. Major end points of ablation weren＇t achieved in all patients with inducible AVNRT in the first EPS and recurrent tachycardia after ablation. The recurrent rate of tachycardia was 38% in patients with suspected AVNRT but neither with dual atrioventricular nodal pathway conduction and inducible tachycardia in EPS, nor undergoing slow-pathyway catheter ablation. Conclusions Empirical slow-pathway catheter ablation is safe and effective in the treatment of suspected AVNRT. No dual atrioventricular nodal pathway conduction after catheter ablation might be a reliable end point. Empirical slow-pathway catheter ablation might be a selective strategy in patients with suspected AVNRT but without dual pathway conduction and inducible tachycardia in EPS.

关 键 词：经导管射频消融 慢径路 房室结折返性心动过速 

分 类 号：R541.71[医药卫生—心血管疾病]