射频消融房室结折返性心动过速中无交界性心律反应的消融策略探讨  

Technique of slow-pathway ablation in patients with atrioventricular nodal reentrant tachycardia without junctional rhythm

作　　者：李飞鸥 张建军[1] 陈明[1] 杨新春[1] LI Feiou;ZHANG Jianjun;CHEN Ming;YANG Xinchun(Heart center,Beijing Chaoyang Hospital,Capital Medical University,Beijing,100043,China)

机构地区：[1]首都医科大学附属北京朝阳医院心内科,北京100043

出　　处：《临床心血管病杂志》2018年第10期998-1001,共4页Journal of Clinical Cardiology

基　　金：北京市自然科学基金(No:7142062)

摘　　要：目的:射频消融房室结折返性心动过速(AVNRT)患者,探讨消融过程中无交界性心律(JR)出现的患者消融策略。方法:对完成AVNRT慢径射频消融成功的867例成人患者进行回顾性分析,总结分析临床特点、心内电生理特点。结果:根据消融过程有无出现JR分为2组,出现JR组846例,消融过程中采用传统方法以JR出现预测消融成功,无JR组21例,直接以诱发AVNRT验证靶点。两组间比较,在年龄、性别、合并疾病、基础心率、心动过速折返类型和靶点特性上无统计学差异(P>0.05)。两组术后经过为期1年随访:出现JR组,1例术中出现一度房室传导阻滞,随访无传导阻滞加重,2例复发,5例失访;无JR组1例患者出现一过性三度房室传导阻滞,术后随访无传导阻滞,无复发及失访病例。结论:慢径消融过程中,缺乏JR是一种少见的临床现象,以解剖结构为定位依据,以诱发AVNRT验证消融有效性,可提高慢径消融成功率,减少消融范围,降低并发症。Objective：To investigate ablation technique of immediate success for AVNRT in patients without junctional rhythm（JR）.Method：The study included 867 adult patients with AVNRT who underwent slow pathway ablation successfully.The clinical data,electrophysiological characteristics were reviewed.Result：One group had 846 patients with JR that used to be a marker of procedural success,and another group had 21 patients without JR which inducibility of AVNRT was assessed after each application of radiofrequency energy.There was no statistical difference between the two groups in age,sex,combined disease,basal heart rate,tachycardia form,and target site（P〉0.05）.One patient of those with JR got one degree atrioventricular block because of ablation and did not worsen with 1 year follow-up.And 5 patients lost follow-up in JR group.There were 2 patients recurrence in JR group versus no recurrence in no JR group after 1 year follow-up.Conclusion：Absence of JR is a rare clinical case,successfully slow-pathway ablation is possible.Inducible AVNRT is assessed after each application of radiofrequency energy.This technique is a safe and effective that could reduce the area of ablation damage and reduce complications.

关 键 词：房室结折返性心动过速 交界性心律 室上性心动过速 KOCH三角 

分 类 号：R541.6[医药卫生—心血管疾病]