间断放电法消融治疗房室结折返性心动过速的临床观察  

Clinical Observation on Intermittent Energy Discharge Approach for the Radio-frequency Ablation of AVNRT

作　　者：时向民[1] 王玉堂[1] 单兆亮[1] 孟凡华[1] 王利[1] 王思让[1] 

机构地区：[1]解放军总医院心内科,北京100853

出　　处：《医学临床研究》2004年第1期24-26,共3页Journal of Clinical Research

摘　　要：【目的】探讨间断放电消融方法治疗房室结折返性心动过速 (AVNRT)对成功率、复发率、房室传导阻滞发生率的影响。寻求AVNRT更加安全有效的治疗方法。【方法】对 1995～ 2 0 0 2年之间住院的 2 0 6例经电生理检查及射频消融治疗的AVNRT患者进行分析。其中男性 10 0例 ,女性 10 6例 ,平均年龄 4 5 (10～70 )岁。所有患者均采用下位法间断放电消融慢径。能量为 2 5～ 30W。放电后 5s内无交界性心律出现则停止放电 ,重新标测靶点。如放电后即刻或稍后出现交界性心律且频率≤ 12 0次 /min ,则每次放电 5～ 10s后停止放电 ,窦性心律恢复后继续放电 5～ 10s。累积放电 90～ 12 0s后重复电生理检查 ,如未达消融终点则重复上述标测和消融过程直到成功。【结果】2 0 6例患者中 2 0 5例治疗成功 ,成功率为 99.5 1%。 2例病人于射频消融术后 3个月内复发 ,复发率 0 .97% ,经再次消融后治愈。并发迟发性Ⅲ度房室传导阻滞 1例 ,发生率为0 .4 8% ,经激素治疗后房室传导逐渐恢复正常。【结论】下位法间断放电消融慢径是房室结折返性心动过速安全有效的治疗方法 ,单次消融超过 30s并非慢径消融成功的必要条件。[Objectives]To explore the effects of intermittent energy discharge approach (IEDA) on the rate of success, rate of recurrence and incidence of atrioventricular block in patients undergone radiofrequency ablation for the treatment of atrioventricular nodal reentrant tachycardia (AVNRT) in order to find out a safer and more effective therapy.From 1995 to 2002, 206 hospitalized patients with typical AVNRT [100 males, 106 females, mean age 45(10～70) years old] were examined by electrophysiological methods and their data were analyzed retrospectively. All of them were subjected to modified slow pathway of ablation with IEDA, the energy used was 25～30 W. If boundary cardiac rhythm did not appear within 5 s after discharge, the discharge would be stopped and target point was rechecked once more.AVNRT was successfully ablated in 205 out of 206 patients,rechecked the rate of success was 99.51 % (205/206), AVNRT recurred in 2 patients within 3 months after ablation, the rate of recurrence was 0.97% (2/206), their arrhythmia was eliminated again by the second ablation. One patient suffered from late complete atrioventricular block (grade Ⅲ) 3 days after ablation, the incidence was 0.48%; the atrioventricular conduction restored after treatment of dexamethasone.[Conclusion]Intermittent energy discharge of radiofrequency is a safe and effective approach for slow pathway ablation of AVNRT. Single ablation exceeding 30 s is not a necessary condition for success.

关 键 词：间断放电法 治疗 房室结折返性心动过速 射频消融 导管 房室传导阻滞 

分 类 号：R654.2[医药卫生—外科学]