成人继发孔型房间隔缺损并发房颤患者三种治疗方法分析

目的介绍成人房间隔缺损（ASD）并发心房颤动（AF）患者的几种治疗方法,并分析其治疗效果。方法：回顾分析本院136例ASD并发有明显临床症状且药物治疗无效的AF病例,其中36例接受介入封堵＋经导管射频消融术（导管射频消融组）,84例体外循环下ASD补术＋改良迷宫术（改良迷宫组）,16例单纯介入封堵术（未行经导管射频消融术,单纯介入封堵组）,术前,术后12月用心脏超声仪评价右心房、右室内径及肺动脉压力和心电图变化。结果：所有病例的术中、术后均未出现严重并发症,所有病例均无死亡,随访12个月,36例接受介入封堵＋经导管射频消融术28例转复为窦性心律,8例仍为AF,后行二次射频消融术转为窦性心律,84例ASD补术＋改良迷宫手术患者中有66例转复窦性,14例失败仍为AF,4例为交界性心律,单纯介入封堵组16例8例成功,8例术后仍为AF,与术前比较,各组心脏超声检查示右心房、右心室内径均较术前明显缩小,肺动脉压力明显下降（均P〈0．05）。各组之间无显著差异。经导管射频消融组和改良迷宫手术组AF治愈率高（对比单纯介入组,均P〈0．05）,患者心慌不适更能得到改善,生活质量更高。结论：介入封堵及外科手术均能安全有效治疗ASD并发AF,每种方法各有利弊,可依据患者临床具体情况选择。     

经导管射频消融治疗预激综合征方法学初探

作者采用40MHz的射频对6例预激综合征并阵发性室上性心动过速的患者分别行冠状窦消融和房室结改良术,2例有效。初步认为冠状窦消融有一定局限性。此与射频消融作用局限需精确定位以及旁道远离冠状窦内标测电极有关。用房室结改良术或用吸附电极导管有望提高治疗预激综合征的疗效。     

射频迷宫术治疗心房颤动

为探讨射频迷宫术治疗心房颤动（简称房颤）的效果，比较１８例二尖瓣置换术中加做迷宫术（治疗组）和１８例单纯二尖瓣置换术（对照组）的慢性房颤治疗结果。治疗组前２例采用切割冷冻法完成迷宫术，后１６例采用改良的射频法。其中１６例（８８．９％）于术后当日至２２日转为窦性心律。切割冷冻法有１例因术后出血给予大量输血引起急性肾功能衰竭而死亡，余未见明显并发症。随访２～１２个月未见房颤复发。对照组中５例曾于术后恢复短暂窦性心律，但出院时又转为房颤。结果表明迷宫术能有效地治愈慢性房颤，改良的射频法比切割冷冻法操作简单，无出血并发症，心房肌损伤小。提示心房的大小、ｆ波的粗细、心功能的好坏等是影响迷宫术成功的因素     

导管射频消融改良房室结治疗快心室率心房颤动结果的评价

采用房室结有效不应期和文氏点、心房肌波长指数，心室率等指标的变化评价导管射频消融改良房室结治疗心房颤动的疗效。方法９例患者，８例为阵发性房颤，１例持续发性房颤。７例诊断特发性房颤。电生理检查与导管射频消融一次完成。     

射频消蚀右侧房室旁路的体会

以导管射频消蚀右侧房室旁路患者２２例，占同期消蚀旁路总数的２２％；其中包括显性者１３例（５９％），隐性者９例（４１％）。２例合并有Ｍａｈａｉｍ氏束，１例合并有隐性左侧旁路。全部消蚀成功，随访１～１１个月，３例复发（１４％），均已再次消蚀成功。我们认为准确的旁路定位及消蚀导管与靶组织的接触是成功的关键。     

射频导管消融改良房室结术中发生一过性完全性房室传导阻滞的预后意义

目的：探讨射频导管消融改良房室结术中发生一过性完全性房室传导阻滞（ＴＣＡＶＢ）的预后意义。方法：对５６例房室结折返性心动过速病人行射频导管消融治疗。在射频导管消融术中发生ＴＣＡＶＢ者为Ｉ组（ｎ＝６），无ＴＣＡＶＢ者为Ｉ组（ｎ＝５０）。用ｔ检验和χ２检验对所有指标进行统计学分析。结果：两组的平均放电次数、释放能量、放电时间及Ａ／Ｖ比值均无显著差异（Ｐ＞０．０５），但消融电极位置偏高者Ｉ组占６６．７％，Ｉ组占１２．０％（Ｐ＜０．００１）。在随访期间，Ｉ组２例（３３．３％）发生迟发性房室传导阻滞，Ｉ组则无迟发性房室传导阻滞发生（Ｐ＜０．００１）。结论：射频导管消融术中出现的ＴＣＡＶＢ与术后发生的迟发性房室传导阻滞密切相关。     

间隔部射频消融对自主神经张力的非一过性影响

本文将间隔部射频消融（ＲＦＣＡ）患者２２例（含１８例改良慢径消融）和游离壁ＲＦＣＡ患者２０例作术后４８至７２小时的心率变慢性（ＨＲＶ）研究。结果表明，两组ＲＦＣＡ的功率及时间无显著性差异，间隔部ＲＦＣＡ组ＬＦＰ／ＨＦＰ比值较术前显著增加，提示ＨＲＶ减低，而游离壁组术前、术后无显著性差异。     

射频导管消融术治疗WPW综合征

射频导管消融术治疗ＷＰＷ综合征英／ＶｉｒｇｉｎｉａＡ···ＨＥＡＲＴ　￡　ＬＵＮＧ·１９９３，２２（１），－１５－２５本文描述了ＷＰＷ综合征伴有反复发作性心动过速的病理生理学、心电图表现、长短期治疗的用药方案及射频导管消融术在预防和治疗中的应用。ＷＰ...     

射频导管消融术治疗阵发性室上性心动过速30例临床体会

本文叙述30例均为阵发性室心性心动过速（简称室上速），采用射频导管消融术，其成功率19例，失败1例，成功率96.6％。显性旁路消融成功靶点腔内心电图特征为：宾性心律不、AV融合或很靠近、V波较体表心电图最早的delta被提前＞20ms，A／V＜1。隐匿劳路消融成功靶点腔内心电图特征为：心室起搏或心动过速时VA融合或很靠近，逆转A波最提前，A／V＜l。房室结改良患者采用下位法消融节省时间，且成功率高。射频导管消融术关键是旁路定位准确性和导管操作准确性。该方法是比较安全、可靠、有效。射频导管消融术治疗阵发性室上性心动过速30例…     

导管射频消蚀隐匿性慢旁路心动过速五例报告

导管射频消蚀隐匿性慢旁路心动过速五例报告杨延宗，林治湖，高连君，王莹琦，黄丽萍，丛培欣报告应用导管射频消蚀术（ＲＦＣＡ）阻断５例隐匿性慢旁路，使顽固性反复发作性心动过速得到根治的经验。资料：男３例，女２例，年龄２８～６４岁，均有１０年以上心动过速史，...     

Ventricular fibrillation as a primary manifestation of Wolff–Parkinson–White syndrome

Wolff–Parkinson–White syndrome (WPW) is defined as a condition involving an accessory pathway associated with symptoms. A typical ECG pattern of a pre-excitation shows a short PQ interval, presence of delta wave and a broad QRS complex on surface ECG. The underlying mechanism involves an accessory pathway, which enables conduction of a depolarization wave from atria to ventricles bypassing the AV node and predisposes to arrhythmias and sudden cardiac death. The most common arrhythmia in patients with WPW syndrome is atrioventricular reentrant tachycardia. However, it is not present in all patients with pre-excitation [1], [2], [3], [4]. Up to 1/3 of patients with AVRT experience atrial fibrillation, which may be conducted to ventricular myocardium via the accessory pathway and lead to a life-threatening ventricular fibrillation. The most effective treatment of the WPW syndrome is a radiofrequency catheter ablation [2], [5], [6], [7], [8]. This paper describes a case of a 40-year-old woman after a cardiopulmonary resuscitation for ventricular fibrillation, which was a primary manifestation of the WPW syndrome. It focuses on pathophysiology, clinical pattern and treatment possibilities of patients with WPW syndrome.     

Postcardiac injury syndrome complicating radiofrequency ablation of the atrioventricular node

Radiofrequency ablation, which is increasingly used in the treatment of cardiac arrhythmia, can be complicated with pericardial effusion and one case of Dressler's syndrome has already been reported after an atrioventricular pathway ablation. This case reports a second case complicating an atrioventricular node radiofrequency ablation procedure.     

A permanent junctional reciprocating tachycardia with an atypically located accessory pathway successfully ablated from within the middle cardiac vein

Permanent form of junctional reciprocating tachycardia (PJRT) is an uncommon form of atrioventricular re-entrant tachycardia due to an accessory pathway characterized by slow and decremental retrograde conduction. The majority of accessory pathways in PJRT are localized in the posteroseptal zone. Despite the high success rate, failure may occur during endocardial radiofrequency catheter ablation due to epicardial insertion of the accessory pathway. We report a case of PJRT in a 25-year-old man in whom the accessory pathway was located epicardially in the posteroinferior region and ablated from within the middle cardiac vein by radiofrequency catheter ablation.     

Comparison of late results of surgical or radiofrequency catheter modification of the atrioventricular node for atrioventricular nodal reentrant tachycardia.

AIMS: Although arrhythmia surgery and radiofrequency catheter ablation to cure atrioventricular nodal reentrant tachycardia differ in technical concept, the late results of both methods, in terms of elimination of the arrhythmogenic substrate and procedure-related new and different arrhythmias, have never been compared. This constituted the purpose of this prospective follow-up study. METHODS AND RESULTS: Between 1988 and 1992, 26 patients were surgically treated using perinodal dissection or 'skeletonization', and from 1991 up to 1995, 120 patients underwent radiofrequency modification of the atrioventricular node for atrioventricular nodal reentrant tachycardia. The acute success rates of surgery and radiofrequency catheter ablation were 96% and 92%, respectively. Late recurrence, rate in the surgical and radiofrequency catheter ablation groups was 12% and 17%, respectively. Mean follow-up was 53 months in the surgical group and 28 months in the radiofrequency catheter ablation group. The final success rate after repeat intervention was 100% in the surgical group and 98% in the radiofrequency catheter ablation group. Comparison of the initial and recent series of radiofrequency catheter ablated patients showed an increased initial success rate with fewer applications. In the radiofrequency catheter ablation group, a second- or third-degree block developed in three patients (2%), requiring permanent pacing, whereas in the surgical group no complete atrioventricular block was observed. Inappropriate sinus tachycardia needing drug treatment was observed in 13 patients (11%), mostly after fast pathway ablation, but was never observed after surgery. New and different supraventricular tachyarrhythmias arose in 27% of the patients in the surgical group and in 11% of the radiofrequency catheter ablation group, but did not clearly differ. CONCLUSION: This one-institutional follow-up study demonstrated comparable initial and late success rates as well as incidence of new and different supraventricular arrhythmias following arrhythmia surgery and radiofrequency catheter ablation for atrioventricular nodal reentrant tachycardia. Today radiofrequency catheter ablation has replaced arrhythmia surgery for various reasons, but the late arrhythmic side-effects warrant refinement of technique.     

Case Report: Clinical AV Nodal Reentrant Tachycardia in a Patient with Left Sided Accessory Pathway and Immediate Occurrence of Antidromic AV Reentrant Tachycardia after Slow Pathway Ablation

The only inducible arrhythmia in a patient with exclusive antegrade conducting left anterolateral accessory pathway, consists of slow/fast atrioventricular nodal reentrant tachycardia. After radiofrequency catheter ablation of the slow pathway, true antidromic AV reentrant tachycardia was easily induced by atrial pacing. Following ablation of the accessory pathway no arrhythmia could be induced.     

Clinical and electrophysiological study of asymptomatic Wolff-Parkinson-White syndrome

AIM: This study was designed to describe clinical characteristics and electrophysiologic in patients with asymptomatic Wolff-Parkinson-White syndrome. METHODS: From December 2000 to August 2005, a total of 154 patients with accessory pathway-mediated reentry mechanism underwent electrophysiologic studies at Sainte-Marguerite and Timone hospitals in Marseille. Ninety-six patients had WPW syndrome, out of which 78 were symptomatic patients and 18 were asymptomatic. The mean age was 26 years. Sex (masculine) 17. RESULTS: The incidence of intermittent arrhythmia associated with Wolff-Parkinson-White syndrome was lower in 2 patients (11%). There was a higher occurrence of rapid induced tachycardia in 9 patients (50%). However, atrial fibrillation occurred more commonly in 6 (33%) patients. The anterograde accessory pathway effective refractory period (APRP) in patients was much shorter (less than 250 ms [N=16]) 13 patients with accessory pathways were managed by ablation. CONCLUSION: This study demonstrated the difference in the electrophysiologic characteristics of anterograde accessory pathway and the atrioventricular node in asymptomatic WPW patients, and thus concluded that radiofrequency (RF) catheter ablation is a safe and effective method to manage patients with asymptomatic WPW syndrome.     

Clinical application of radiofrequency ablation]

I. Radiofrequency ablation of atrioventricular accessory pathway in patients with WPW syndrome: Seventeen accessory pathways in 15 patients with Wolff-Parkinson-White syndrome (WPW) were ablated with radiofrequency current. There were 15 accessory pathways located on the left side of the heart (12 left free wall, 1 posterioseptal, 1 posteriolateral and 1 midseptal) and 2 pathways on the right side (1 right free wall, 1 anterioseptal). 16 accessory pathways (94.1%) in 14 patients were permanently abolished. Plasma CK-Mb, SGOT and LDH increased moderately in 7 cases (46.7%) and decreased to normal level in 3-4 days. Conclusion: catheter ablation of accessory pathways with radiofrequency current is a safe and effective therapeutic method for patients with refractory tachycardias mediated by these pathways. II. Radiofrequency ablation of slow pathways to cure AV nodal reentrant tachycardia: Radiofrequency energy was used to selectively ablate the slow pathways in 8 patients with atrioventricular nodal reentrant tachycardia. The slow pathways in all 8 cases were ablated successfully and no episodes of tachycardia could be induced. The A-H, H-V interval and P-R interval of ECG did not change significantly. The Wenckebach points of atrioventricular node remained unchanged. The effective refractory periods of the fast pathways were shortened in 3 and prolonged in 5 cases after the procedure. There were no severe complications. No tachycardia recurred during the follow-up period between 2 weeks and 7 months.     

预激合并室上性快速心律失常所致的心肌病

４例因长期心动过速而发生心功能障碍的患者，经检查除外其他器质性心脏病后，予以射频消融终止心动过速。分别于术后２周及４个月行超声心动图检查，结果显示ＬＶＥＦ、ＬＶＥＤＤ、ＬＶＥＳＤ均较术前有明显改善。提示对于长期快速心律失常患者，即使在心功能受损的情况下，也应积极治疗，以便改善患者预后。     

Impact of radiofrequency catheter ablation of accessory pathways on the frequency of atrial fibrillation during long-term follow-up; high recurrence rate of atrial fibrillation in patients older than 50 years of age.

AIMS: Atrial fibrillation represents a frequent and potentially life-threatening arrhythmia in patients with accessory atrioventricular pathways. Radiofrequency ablation has become the curative treatment of first choice for these patients. Investigations after successful surgical pathway dissection reported an almost complete elimination of paroxysmal atrial fibrillation. However, there are only a few reports which include a small number of patients undergoing radiofrequency ablation. The purpose of this study was to examine whether successful radiofrequency ablation of accessory pathways prevents the occurrence of paroxysmal atrial fibrillation, and to identify possible predictors of atrial fibrillation recurrence. METHODS AND RESULTS: A total of 116 consecutive patients (mean age 42+/-15 years) with manifest or concealed accessory pathways and documented paroxysmal atrial fibrillation underwent radiofrequency catheter ablation. The patients were reexamined at 6 and 12 months. Long-term follow-up information was obtained by questionnaire and/or by consulting the referring physician. Pathway conduction was abolished in 101 cases (87%). Late follow-up information was obtained from 91 of these 101 patients (90%) with successful ablation with a mean follow-up duration of 23.9+/-12.3 months. During follow-up, 25 of 91 patients (27%) experienced arrhythmias. Recurrent episodes of atrial fibrillation were observed in 18 of these 25 cases (i.e. 20% of the 91 patients). Differences between patients with and without recurrences of atrial fibrillation were examined for age, sex, associated cardiac disease, presence of multiple pathways, pathway location, atrial fibrillation inducibility during the procedure and cycle length of the atrioventricular reentrant tachycardia. Only older age was a significant independent predictor of atrial fibrillation recurrence (P=0.02). Eleven of 31 patients (35%) older than 50 years of age had atrial fibrillation recurrences during follow-up compared to seven of 60 patients (12%) under age 50. The recurrence rate of atrial fibrillation was even higher in patients older than 60 years (6 of 11 patients, i.e. 55%). In comparison, the occurrence rate of atrial fibrillation during follow-up in a control group of 100 consecutive patients with successful accessory pathway ablation, who did not have evidence of paroxysmal atrial fibrillation prior to ablation, was 4% and, thus, significantly lower than in the study group of the 91 patients (P=0.001). CONCLUSIONS: The recurrence rate of paroxysmal atrial fibrillation after successful radiofrequency ablation of accessory pathways shows an age-related increase, being low in patients younger than 50 years of age (12%) and high in the older patients: 35% in patients older than 50 years and 55% in patients older than 60. These results have significant therapeutic implications concerning the decisions on pharmacological therapy after successful ablation in patients older than 50 years. Furthermore, these data will help physicians advise older patients properly about their risk of recurrence of atrial fibrillation after ablation.