Koch三角基底部线性消融治疗房室结折返性心动过速的价值  

Linear ablation at the Koch triangle basement in the treatment of atrioventricular nodal reentry tachycardia

作　　者：刘醒存[1] 陆永光[1] 黄军章[1] LIU Xingcun;LU Yongguang;HUANG Junzhang(Department of Cardiology,the Second People's Hospital of Qinzhou,Qinzhou535000,China)

机构地区：[1]钦州市第二人民医院心内科,广西钦州535000

出　　处：《中华实用诊断与治疗杂志》2020年第5期480-482,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：广西壮族自治区卫生和计划生育委员会科研课题(Z20170967)。

摘　　要：目的探讨常规中下位点状射频消融治疗后残存慢径路的房室结折返性心动过速(atrioventricular nodal reentrant tachycardia,AVNRT)患者应用Koch三角基底部线性消融治疗的疗效及安全性。方法常规中下位点状射频消融治疗后残存慢径路的AVNRT患者60例,随机分为观察组和对照组各30例,观察组给予Koch三角基底部线性消融,对照组给予常规中下位点状射频消融治疗。记录2组慢径路阻断率及术后7d并发症发生情况;比较2组治疗前及慢径路未阻断者治疗即刻慢径路心房起搏时最长房室束A-H期间(A-Hmax)、有效不应期(effective refractive period,ERP);随访1年,比较2组复发率。结果2组术后7d均无并发症发生。观察组慢径路阻断率(66.7%)高于对照组(40.0%)(P<0.05)。观察组治疗前慢径路A-Hmax[(318.78±45.55)ms]、ERP[(279.98±54.34)ms]与对照组[(312.78±17.55)、(282.98±17.34)ms]比较差异无统计学意义(P>0.05)。观察组慢径路未阻断者治疗即刻A-Hmax[(275.56±15.78)ms]较对照组[(294.05±18.21)ms]缩短,ERP[(315.55±19.56)ms]较对照组[(301.26±18.99)ms]延长(P<0.05)。观察组术后1年观察组复发率(0)低于对照组(16.67%)(P<0.05)。结论Koch三角基底部线性消融治疗AVNRT安全、有效,复发率低,可作为常规中下位点状消融治疗后残留慢径路的补充术式。Objective To investigate the efficacy and safety of linear ablation at the Koch triangle basement in the treatment of atrioventricular nodal reentry tachycardia(AVNRT)with residual slow pathway after conventional point radiofrequency ablation.Methods Sixty patients with AVNRT after conventional point radiofrequency ablation were randomly divided into observation group and control group,with 30patients in each group.Observation group underwent linear ablation at the Koch triangle basement,while control group received conventional point radiofrequency ablation.The slow pathway blocking rate and incidence of complications 7days after operation were recorded in two groups.The longest atrioventricular bundle A-H period(A-Hmax)and effective refractive period(ERP)before and after the treatment were compared in two groups.The recurrence rates were compared between two groups after 1-year follow-up.Results No complications occurred in 7days after operation in both two groups.The low pathway blocking rate was higher in observation group(66.7%)than that in control group(40.0%)(P<0.05).A-Hmaxand ERP showed no significant differences before treatment between observation group((318.78±16.56),(279.98±54.34)ms)and control group((312.78±17.55),(282.98±17.34)ms)(P>0.05).The A-Hmaxwas shorter and ERP was longer in observation group((275.56±15.78),(315.55±19.56)ms)than that in control group((294.05±18.21),(301.26±18.99)ms)after treatment(P<0.05).The recurrence rate was lower in observation group(0)than that in control group(16.67%)(P<0.05).Conclusion Linear ablation at the Koch triangle basement is safe and effective for AVNRT,and could be used as a complementary procedure for AVNRT with residual slow pathway after conventional point radiofrequency ablation.

关 键 词：房室结折返性心动过速 残存慢径路 线性消融 Koch三角基底部 

分 类 号：R541.71[医药卫生—心血管疾病]