房室折返性心动过速射频消融术后复发原因分析  

Analysis of recurrence after radiofrequency ablation in patients with atrioventricular reentrant tachycardia

作　　者：黄俊 丁立刚 李宜富 李腾 廖志勇 阮焕钧 彭文杰 李华龙 李超 姚焰 HUANG Jun;DING Li-gang;LI Yi-fu;LI Teng;LIAO Zhi-yong;RUAN Huan-jun;PENG Wen-jie;LIHua-long;LI Chao;YAO Yan(Shenzhen Hospital,Fuwai Hospital Chinese Academy of Medical Sciences,Shenzhen 518000,Guangdong,China;Cardiac Arrhythmia Center,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences,Beijing 100037,China)

机构地区：[1]中国医学科学院阜外医院深圳医院,广东深圳518000 [2]中国医学科学院阜外医院国家心血管病中心北京协和医学院,北京100037

出　　处：《中国心脏起搏与心电生理杂志》2020年第4期360-364,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的探讨房室折返性心动过速(AVRT)患者射频消融(RFCA)术后复发率、复发原因。方法回顾分析2017年1月至2019年10月间收治的323例AVRT患者的临床资料、首次射频消融术资料、随访结果和复发患者二次射频消融术资料。结果 323例患者中男性196(60.9%)例,年龄(40.2±14.3)岁,术中即刻成功率99.7%,随访(20.0±12.7)个月,复发21(6.5%)例。复发患者的旁道分布:左侧游离壁10例、右侧游离壁7例、前间隔2例、后间隔2例。术中使用三维标测的复发率低于传统标测复发率(2.8%vs 9.5%,P=0.015),与复发组相比未复发组V/A融合时限短[(74.3±3.6)ms vs (80.7±3.1)ms,P<0.05],逆传A波更提前[(24.2±2.8)ms vs (17.3±3.9)ms,P<0.05],靶点心室电位提前QRS波时间更长[(25.4±2.3)ms vs (22.2±1.4)ms,P<0.05],消融反应时间更短[(4.4±1.8)s vs (8.9±3.5)s,P<0.05]。左侧旁道患者术中采用主动脉逆行途径的复发率低于穿间隔途径(1.8%vs 7.1%,P<0.05)。多因素回归分析显示,术中是否使用三维标测、消融反应时间、逆传A波提前程度是复发的影响因素。复发患者中有20例接受了二次消融手术均消融成功,随访(12.2±8.0)个月未见复发。结论导管消融术治疗AVRT成功率高,复发率较低。术中是否使用三维标测、消融反应时间、逆传A波提前程度是复发的影响因素。Objective To retrospectively analyze the rate, the reasons and the strategies of recurrence after radiofrequency ablation(RFCA) in patients with atrioventricular reentrant tachycardia(AVRT). Methods Reviewed 323 AVRT patients underwent RFCA in our hospital from January 2017 to October 2019 with the clinical data, primary operation data,the follow-up result and secondary operation data and analyzed the causes of recurrent. Results Among the 323 AVRT patients, 196(60.9%) were males, with an average age of(40.2±14.3) years, immediate success rate 99.7%,The follow-up was(20.0±12.7) months and 21 cases(6.5%) recurred.The distribution of accessory pathways in recurrent patients were left free wall(n=10), right free wall(n=7), anterior septal accessory pathway(n=2) and posterior septal accessory pathway(n=2). There were significant differences in the use of three-dimensional mapping(2.8% vs 9.5%), the time limit of V/A fusion[(74.3±3.6)ms vs(80.7±3.1)ms], the advance of retrograde A wave[(24.2±2.8)ms vs(17.3±3.9)ms],durations of local ventricular electrogram of ablation site preceded the onset of QRS [(25.4±2.3)ms vs(22.2±1.4)ms,P<0.05] and the reaction time of ablation[(4.4±1.8)s vs(8.9±3.5)s] between the non-recurrent group and the recurrent group(all P< 0.05). The recurrence rate of retrograde aortic pathway in patients with left accessory pathway was lower than that of transseptal approach(1.8% vs 7.1%).Multivariate regression analysis showed that intraoperative use of three-dimensional mapping,ablation reaction time and the degree of retrograde A wave advance were the influencing factors of recurrence.Among the recurrent patients,20 patients underwent secondary ablation,All were successfully ablated during a follow-up of(12.2±8.0)months.Conclusion This study shows that the success rate of catheter ablation in the treatmentof AVRT is high and the recurrence rate is low.The influencing factors of recurrence were the use of three-dimensional mapping during operation,the reaction time of ablation and the adv

关 键 词：电生理学 房室折返性心动过速 旁道 射频消融术 复发 

分 类 号：R541.7[医药卫生—心血管疾病] R454.1[医药卫生—内科学]