射频消融术在房缺封堵术后继发房性心动过速中的价值  

Value of radiofrequency ablation for secondary atrial tachycardia after interventional closure in patients with atrial septal defect

作　　者：许巧凤[1] XU Qiao-feng(Department of functional examination section,Chenzhou first people's hospital in Hu'nan Province,Chenzhou 423000,China)

机构地区：[1]郴州市第一人民医院功能检查科,湖南郴州423000

出　　处：《中国处方药》2020年第11期10-12,共3页Journal of China Prescription Drug

摘　　要：目的通过回顾性总结基于CARTO三维标测系统的导管射频消融术与单纯药物保守治疗在先天性房间隔缺损(ASD)成人患者经介入封堵术后继发房性心动过速干预中的效果。方法回顾性总结2014年5月~2019年10月诊断成人单纯ASD患者经介入封堵术治疗共452例,随访其中68例(15.0%)继发典型房性心动过速,发生时间为术后1~5年,中位时间3.6年;68例患者中40例选择单纯药物保守治疗(药物组),另28例选择射频消融术(消融组)。比较两组患者恢复窦性心律的百分比、窦性心律维持时间、复发率、平均心率。结果药物组以胺碘酮应用率最高,其他药物有普罗帕酮、美托洛尔,平均用药种类(1.8±0.5),恢复窦性心律8例(20.0%),窦性心律维持时间(2.5±0.6)个月,复发8例(100%),平均心率(125.5±15.6)次/分。消融组均成功完成手术,平均手术时间(55.6±12.3)min,共标测37种房性心动过速,在折返环关键峡部或最早激动点进行消融,首次消融成功20例(71.4%),窦性心律维持时间(18.9±4.5)个月,复发9例(32.1%),平均心率(87.4±6.9)次/分。消融组恢复窦性心律的百分比明显高于药物组,窦性心律维持时间明显延长,复发率降低,平均心率下降(P<0.05)。结论针对成人ASD经介入封堵术后继发房性心动过速患者采用CARTO三维标测系统的导管射频消融术较单纯药物保守治疗具有较好的安全性和较高的成功率,对恢复窦性心律、延长窦性心律维持时间、降低平均心率和复发率有较好的应用价值。Objective To retrospectively summarize the effect of radiofrequency catheter ablation(RFCA)based on three-dimensional mapping system of CARTO and simple drug conservative treatment for secondary atrial tachycardia in adult patients with congenital atrial septal defect(ASD)after transcatheter closure.Methods A retrospective summary was made of 452 adult patients with ASD by interventional occlusion from May 2014 to October 2019.Sixty-eight patients(15.0%)were followed up with typical atrial tachycardia,which occurred 1~5 years after operation,with median time of 3.6 years.Forty-eight patients were treated with drug-only conservative therapy(drug group)and 28 patients were treated with radiofrequency ablation(ablation group).The percentage of patients recovering sinus rhythm,duration of sinus rhythm maintenance,recurrence rate and average heart rate were compared in the two groups.Results In drug group,amiodarone was most commonly used,other drugs were propafenone and metoprolol,with average of(1.8±0.5),8 cases(20.0%)recovering sinus rhythm,8 cases(100%)relapsing and average heart rate of(125.5±15.6)bpm.In ablation group,37 atrial tachycardias were mapped and ablated at critical isthmus or earliest excitation point of reentry ring.The first ablation was successful in 20 cases(71.4%),duration of sinus rhythm maintenance was(18.9±4.5)months,9 cases(32.1%)recurred,and average heart rate was(87.4±6.9)bpm.Percentage of sinus rhythm recovery in ablation group was significantly higher than drug group,duration of sinus rhythm maintenance was prolonged,recurrence rate was reduced,and average heart rate was decreased(P<0.05).Conclusion Radiofrequency catheter ablation with CARTO three-dimensional mapping system for adult ASD patients with secondary atrial tachycardia after transcatheter closure is safer and more successful than drug conservative therapy alone,which has better application value in restoring sinus rhythm,prolonging sinus rhythm maintenance time,reducing average heart rate and recurrence rate.

关 键 词：房间隔缺损 介入封堵术 房性心动过速 导管射频消融术 

分 类 号：R541.71[医药卫生—心血管疾病]