压力导管射频消融治疗房室结折返性心动过速患者对其术中残余回波的影响  

Effect of contact force catheter on residual echo in patients with atrioventricular nodal reentrant tachycardia during radiofrequency ablation

作　　者：黄英杰[1] 吴樱[1] 詹贤章[1] HUANG Ying-jie;WU Ying;ZHAN Xian-zhang(Guangdong Cardiovascular Institute,Guangdong Provincial People′s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510100,China)

机构地区：[1]广东省心血管病研究所广东省人民医院(广东省医学科学院),广州510100

出　　处：《岭南心血管病杂志》2022年第3期241-245,共5页South China Journal of Cardiovascular Diseases

摘　　要：目的观察房室结折返性心动过速(atrioventricular nodal reentrant tachycardia,AVNRT)患者射频消融术中残余回波的分布规律,研究术中使用压力消融大头是否能减少残余回波的出现。方法纳入2020年8月至2021年8月广东省人民医院慢-快型房室结双径路所致的AVNRT患者56例,均使用TactiCath Quartz(TCQ)光感应压力消融大头。将入选患者按随机数字表法随机分成试验组(显示压力组)和对照组(隐藏压力组),均行射频消融手术,在常规部位(小A大V)消融后,观察残余回波的分布规律,以及相关数据的对比。结果两组患者消融点数及手术时间比较,差异无统计学意义(P>0.05);但试验组患者贴靠压力明显比对照组要高,差异有统计学意义(P<0.05);两组间出现残余回波的个数,在统计学上有显著性差异的倾向(P=0.057)。残余回波的分布,最多见于更靠近HIS区域(12例),其次是更靠近心房区域(4例)和冠状窦口顶部区域(4例)。结论使用压力导管对于靶点贴靠的准确性明显高于非压力导管,贴靠更好,可能会减少残余回波的发生。残余回波大部分分布于更靠近HIS区,其次分别为更靠近心房区和冠状窦口顶部区,分布特点与慢-快型AVNRT的折返环相符合。Objective To observe the distribution of residual echo in radiofrequency ablation for patients with atrioventricular nodal reentrant tachycardia(AVNRT),and to study whether the use of contact force catheter can reduce the occurrence of residual echo.Methods Totally 56 patients with AVNRT caused by slow-fast atrioventricular nodal dual pathway from August 2020 to August 2021 in Guangdong Provincial People’s Hospital were selected.They were randomly divided into experimental group(showing pressure group)and control group(hiding pressure group).Tacti C.ath Quartz(TCQ)contact force catheter was used for radiofrequency ablation.After ablation at conventional sites(small A and large V),the distribution of residual echo and the comparison of relevant data were observed.Results There was no significant difference in the number of ablation points and operation duration between the two groups(P>0.05);but the adhesion pressure in experimental group was significantly higher than that in control group(P<0.05).There was a tendency to have significant differences in statistics in the number of residual echoes between the two groups(P=0.057).The distribution of residual echo was most common in the area closer to His bundle(12 cases),followed by the area closer to atrium(4 cases)and the top area of coronary sinus orifice(4 cases).Conclusions The use of contact force catheter for target adhesion is significantly better than that of normal catheter,which can reduce the occurrence of residual echo.Most of the residual echoes are distributed in the area closer to His bundle,followed by the area closer to atrium and the top of coronary sinus orifice,which is consistent with the reentry ring of slow-fast AVNRT.

关 键 词：慢-快型房室结折返性心动过速 压力导管 射频消融术 回波 

分 类 号：R541.7[医药卫生—心血管疾病]