射频消融治疗室上性心动过速的临床研究

采用射频消融(RFCA)治疗室上性心动过速(SVT)21,其中旁道(AP)参与的房室折返性心动过速(AVRT)13例(左侧显性AP6例,左侧隐匿性AP4例,右侧显性AP3例);房室结折返性心动过速(AVNRT)8例.13例AVRT患者的15条AP均被阻断;8例AVNRT患者阻断慢径7例、快径1 例.21例SVT患者均获首次消融成功,无明显并发症,成功率为100%,随诊2～15个月无SVT复发.     

射频消融治疗阵发性室上性心动过速的体会

报道 9例射频消融 ( RFCA)治疗阵发性室上性心动过速的初步体会。其中房室折返性心动过速 ( AVRT) 7例 ,房室结折返性心动过速 ( AVNRT) 2例。RFCA后 9例均不再发室上性心动过速。有些左右难辨的后间隔旁道 ,可先标右后标左。在左后间隔难以消融成功的病例 ,不妨在右后间隔标测消融。     

起源于间隔部位阵发性室上速的特点及疗效分析

目的 研究起源于间隔部位的阵发性室上速电生理及射频消融特点.方法 对210例最早心房激动点在间隔部位的阵发性室上速电生理检查,采用心房心室S1S1、S2S2,必要时S1S2S3、RS2等刺激.和(或)静脉点滴异丙基肾上腺素以诱发心动过速,分析电生理特点,明确诊断.每例均经射频消融治疗.结果 房室结双径路伴房室折返性心动过速(AVNRT)150例,间隔房速5例,间隔旁道55例.电生理检查时间2～20min,平均(5±1.2)min.射频消融治疗AVNRT即刻成功率100%,复发率5%;房速即刻成功率100%,复发1例;旁道即刻成功率96%,有2例未成功,复发率4%.无一例严重并发症发生,Ⅲ度房室传导阻滞发生率0%.结论 起源于间隔部位的阵发性室上速可以通过简单的电生理检查步骤作出快速鉴别诊断,其射频消融治疗通过恰当的方法及严密观察心电图和影像图可以明显减少或防止严重并发症Ⅲ度房室传导阻滞的发生.     

射频消融治疗阵发性室上性心动过速103例回顾分析

目的总结阵发性室上性心动过速(PSVT)的射频消融(RFCA)治疗的临床经验。方法对103例行RFCA的PSVT患者的射频消融方法、成功率、复发率及并发症等进行回顾性分析。结果103例室上性心动过速中房室结折返性心动过速(AVNRT)38例,房室旁路折返性心动过速(AVRT)65例,消融总成功率89%。随访20.6±24.7个月,AVNRT消融复发率16.7%,永久性Ⅲ度房室传导阻滞(AVB)发生率5.3%;AVRT消融复发率3.6%,永久性Ⅲ度AVB发生率1.5%。结论导管射频消融(RFCA)治疗PSVT安全、有效;熟练的心导管技术、仔细的电生理检查、耐心地寻找最满意的靶点图以及合适的消融能量和时间是提高成功率及最大限度地减少并发症的关键。     

射频消融治疗阵发性室上性心动过速1520例疗效观察

目的探讨阵发性室上性心动过速(PSVT)行射频消融(RFCA)治疗的有效性和安全性。方法回顾分析1998—2011年收治的PSVT患者1520例,所有患者均行心内电生理检查明确PSVT类型并行射频消融治疗。结果 1520例PSVT患者中房室结折返性心动过速(AVNRT)912例(60.0%),房室折返性心动过速(AVRT)578例(38.0%),折返性房性心动过速25例(1.6%),AVNRT与AVRT并存5例(0.3%)。射频消融术后复发35例(2.3%),再次手术成功20例,无效15例(均为房速),总成功率99.0%。术后发生不可逆三度房室传导阻滞并行永久起搏器植入4例,发生假性动脉瘤6例、动静脉瘘1例、穿刺侧下肢深静脉血栓5例、气胸1例,并发症发生率1.1%。结论射频消融是治疗PSVT的安全有效方法,并发症和复发率与电生理类型和解剖特点、消融靶点的位置等有关。     

射频消融与冷冻消融治疗房室结折返性心动过速的比较

射频消融(RF)在心律失常方面的应用已经有了突破性的进展,尤其是对房室结折返性心动过速(AVNRT)已成为根治性治疗手段,但仍存在一些不足。冷冻消融作为治疗AVNRT的新技术,具有更低的并发症、更少的组织损伤、更小的完全房室传导阻滞的风险,弥补了RF的不足。目前,冷冻消融已经在大量患者身上证实至少和RF一样安全、有效。现就RF和冷冻消融AVNRT的原理和临床疗效予以综述,重点分析RF的缺点及冷冻消融的优势。     

经导管射频消融术治疗阵发性室上性心动过速的临床研究

目的 探讨阵发性室上性心动过速(PSVT)患者经导管射频消融术治疗后的临床效果.方法 350例阵发性室上心动过速患者,常规行心腔内电生理检查明确室上性心动过速类型.左侧房室旁道参与的折返性心动过速消融时采用主动脉瓣逆行途径或穿刺房间隔途径标测和消融,右侧房室旁道参与的折返性心动过速经右股静脉标测和消融,房室结折返性心动过速消融采用下位法消融慢径路.结果 350例阵发性室上性心动过速患者中,房室结折返性心动过速201例(57.4％),房室折返性心动过速149例(42.6％).350例阵发性室上性心动过速患者手术即时成功率为99.4％(348/350),术后复发率2.9％(10/348).350例PSVT患者的平均手术时间为(96.5±23.3) min,其中201例房室结折返性心动过速(AVNRT)患者的平均手术时间为(87.2±21.9) min,149例房室结折返性心动过速(AVRT)患者的平均手术时间为(98.4±26.6)min.350例PSVT出现手术并发症6例(1.7％),所有患者均无瓣膜损伤、心包填塞和死亡等严重并发症.结论 射频消融治疗阵发性室上性心动过速安全、有效.术前完善发作时体表ECG和术中详细的心内电生理检查是明确诊断、提高疗效、减少并发症的关键.     

房室结多径路合并多种类型房室结折返性心动过速

目的　探讨房室结多径路 (MAVNP)合并多种类型房室结折返性心动过速 (AVNRT)的诊断和射频消融治疗对策。方法　分析行心电生理检查和射频消融治疗的AVNRT患者 3 5例的临床资料。结果　 3例诊断为MAVNP合并多种类型AVNRT ,其发生率为 8.6% ,均经射频消融慢径成功根治。结论　MAVNP合并多种类型AVNRT可有多种表现 ,需详细的电生理检查并仔细鉴别方能确诊 ,射频导管消融仍是有效的治疗手段。     

射频消融治疗阵发性室上性心动过速

本文总结了 6 4例阵发性室上性心动过速的射频消融治疗 ,其中房室折返性心动过速 (AVRT) 4 4例 ,包括左前侧壁旁路 13例 ,左侧游离壁旁路 15例 ,左后侧壁旁路 2例 ,左后间隔旁路 8例。右后间隔旁路 4例 ,右后壁旁路 2例 ;房室结折返性心动过速 (AVNRT) 2 0例 ;既有旁路 ,又有双径路 1例 ;两条旁路 1例。以导管射频消融阻断旁路及改良房室结构 ,成功率98 4% ,1例出现Ⅲ°房室传导阻滞 ,1例复发 ,再次射频消融后治愈。     

冷冻消融慢径治疗房室结折返性心动过速临床研究

目的探讨冷冻消融慢径治疗房室结折返性心动过速（AVNRT）时有效靶点的分布和冷冻消融的特点。方法选取53例AVNRT患者,常规行心内电生理程序刺激检查及冷冻标测,确定有效靶点后进一步行冷冻消融治疗。结果所有患者冷冻消融治疗均获成功。冷冻消融慢径成功的有效靶点位于希氏束与冠状窦口之间的前区（A区）8例（15．1％）,位于中区（M区）39例（73．6％）,位于后区（P区）6例（11.3％）;其中2例患者在有效靶点行冷冻消融时出现Ⅰ度房室传导阻滞、AH延长,立即停止冷冻,复温后传导即恢复正常;冷冻消融治疗前后快径前传导有效不应期、AH快径最大值均无明显差异（P〉0．05）。结论房室结折返性心动过速行慢径冷冻消融的有效靶点绝大多数分布位于M区,少数分布于A、P区,在特殊的邻近希氏束部位的A区行冷冻消融是安全、可行的,具备独特的优势。     

Automatic modulation of refractoriness of His-Purkinje system during atrioventricular nodal reentrant tachycardia

Objective To illustrate the automatic modulation of refractoriness of His-Purkinje system during atrioventricular nodal reentrant tachycardia (AVNRT) and to discuss the possible mechanisms. Methods Programmed electrical stimulations were performed in high right atrium (HRA) in 8 patients with AVNRT before ablation to induce tachycardia and electrocardiagraphic recordings were done synchronically when AVNRT appeared. Results All the patients had 2∶1 atrioventricular (A-V) conduction when AVNRT began, 2 of whom were blocked below His bundle, 5 above His bundle and 1 unclear. After a duration of 14.03±10.03 s of 2∶1 A-V conduction, 1∶1 A-V conduction with bundle banch block appeared, 3 of which were right bundle branch block (RBBB), 3 left bundle branch block (LBBB), and 2 with both. Bundle branch block disappeared after a duration of 6.87±11.26 s. Conclusion Effective refractory period (ERP) of His-Purkinje system at the beginning of AVNRT was modulated automatically within less than 30-60 s and thus facilitated nodal-ventricular conduction. The mechanism of this is electrical remodeling.     

Occurrence of atrioventricular block during supraventricular tachycardia: What is its possible mechanism?

A female patient was admitted to our hospital for catheter ablation arising from paroxysmal supraventricular tachycardia (PSVT). In the laboratory, PSVT (the earliest retrograde atrial activation at the coronary sinus ostium) with intermittent atrioventricular (AV) block could be induced repeatedly. The tachycardia could be terminated during ventricular pacing without retrograde conduction to the atria. Therefore, orthodromic AV reciprocating tachycardia (AVRT) and atrial tachycardia (AT) could be ruled out and AV nodal re-entrant tachycardia (AVNRT) was subsequently considered. Initial attempts using slow or intermediate AV nodal ablation failed to cure the tachycardia. We considered the possibility of orthodromic AV reciprocating tachycardia (AVRT) with AV block occurring during the tachycardia. The tachycardia was successfully terminated during the ablation of the right posteroseptal pathway at the coronary sinus ostium. We hypothesized about the possible explanation that might help to clarify the phenomenon of AV block during SVT in order to provide some guidance to other clinicians confronted with similar patient challenges in the future.     

Long-term follow-up of patients with P-R prolongation after catheter ablation of slow pathway for atrioventricular node re-entrant tachycardia

BACKGROUND: Long-term impact of interval between P wave and R wave (P-R) prolongation on prognosis of patients with successful catheter ablation of slow atrioventricular nodal pathway was investigated. METHODS: Among 436 patients undergoing slow-pathway ablation for atrioventricular node re-entrant tachycardia (AVNRT), 17 (3.9%) experienced permanent P-R prolongation. Ablation target sites where conduction block was induced were located in mid- or anteroseptum. Fast junctional rhythm with ventriculoatrial conduction block was observed in eight patients immediately before atrioventricular block. RESULTS: Antegrade slow-pathway conduction was eliminated in 16 patients, and retrograde fast- and slow-pathway conduction was abolished in all patients. There was no recurrence of AVNRT after an average of 38 +/- 12 month follow-up. There was no deterioration of atrioventricular block in these patients. Average PR interval prior to hospital discharge and at the end of follow-up was 0.24 +/- 0.02 sec and 0.23 +/- 0.02 sec, respectively (p >0.05). Left ventricular ejection fraction remained unchanged in these patients (p >0.05). CONCLUSIONS: Radiofrequency catheter ablation of slow pathway for AVNRT is associated with a small risk of atrioventricular block. PR prolongation after successful slow-pathway ablation is associated with benign prognosis.     

后前位投照体位心律失常经导管射频消融的临床应用

目的:观察应用胃肠X线机后前位投照体位经导管射频消融治疗左侧旁道的房室折返性心动过速(AVRT)和房室结折返性心动过速(AVNRT)的疗效和安全性.方法:对18例左侧旁道合并AVRT的患者和14例AVNRT的患者根据后前位投照体位的影像,送入冠状电极,以该电极作路标,精确标测靶点图进行消融.结果:消融成功率100%,随访2～12月无复发,1例AVNRT患者在消融中并发Ⅰ度房室传导阻滞,一月后恢复正常房室传导.结论:在无C型臂X机条件下,应用胃肠X线机后前位投照体位,在熟悉后前位的影像学、精确标测靶点图、严格掌握消融方法的条件下,经导管射频消融治疗左侧旁道全并AVRT和AVNRT疗效确切且安全.     

Radiofrequency ablation: a cure for tachyarrhythmias

Radiofrequency (RF) ablation is a new modality of pennanently curing patients with various tachycardias using radiofrequency energy, a technique evolved in the past decade. RF ablation was performed on 913 patients with different tachyarrhythmias from April, 1994 to July, 1999. There were 491 men and 422 females aged 42 +/- 34 years (range 1 to 76 years). Supraventricular tachycardia (SVT) was present in 462 patients, accessory pathway mediated atrioventricular re-entrant tachycardia (AVRT) in 355 patients (377 accessory pathways) and idiopathic ventricular tachycardia (VT) in 96 patients. Amongst the patients with SVT, 402 had atrioventricular nodal re-entrant tachycardia (AVNRT), 22 had atrial flutter, 20 had ectopic atrial tachycardia and 18 had atrial fibrillation. RF successfully abolished the tachycardia in 400/402 patients (99.5%) with AVNRT, 330/377 (87.5%) accessory pathways in patients with AVRT, 14/22 patients (63.6%) of atrial flutter, 18/20 patients (90%) of atrial tachycardia and 79/96 patients (82.3%) with idiopathicVT. Successful AV nodal ablation with pacemaker implantation was done in 10/18 patients with chronic atrial fibrillation with fast ventricular rate and tachycardia induced cardiomyopathy. AV nodal modulation for atrial fibrillation was tried in the remaining 8 patients and was successful in 4 (4/8). The overall success rate for all arrhythmias was 93.6%, and there was no mortality. At a follow-up of 6.8 +/- 5.4 months, there was a recurrence in 34/420 patients (8%), in whom successful re-ablation was performed. One patient with AVNRT and another with a parahisian pathway developed complete heart block and were given pacemakers. One patient developed inferior wall infarction on the next day post RF. There were 4 patients who had pericardial tamponade necessitating pericardiocentesis and 2 patients developed deep vein thrombosis, which was treated conservatively. Thus RF ablation is an effective, safe and curative therapy for various arrhythmias.     

射频消融房室结改良术对房室结电生理功能的影响

比较２３例房室结折返心动过速经导管射频消融房室结改良术治疗前后房室结电生理变化，结果发现，快径前传下不应期明显缩短（Ｐ〈０．０１），且在慢径阻断组与改良组间无明显差异；在慢径改良组，术后前传不应期明显延长（Ｐ〈０．０１），而房室结前传文氏点，房室结逆传不应期，逆传文氏点均无明显的变化，提示射频消融房室结改良术仅影响房室结快径和慢径的前传不应期，对房室结逆传功能无明显影响。     

射频能量时间递增法治疗房室结折返性心动过速

目的：评估射频能量时间递增法治疗４０ 例房室结内折返性心动过速的疗效及安全性。　方法：标测到理想的慢径路靶点后,从小功率（１０～１５ Ｗ）、短时间（５～１０ ｓ）放电开始,如出现交界区早搏或交界区心律,逐渐增加放电功率（２０～２５ Ｗ）和持续时间（３０～６０ ｓ）,并密切观察房室传导阻滞的迹象和先兆。　结果：临床治愈率９７．５％ ,无一例产生严重并发症。　结论：射频能量时间递增法是一种安全、高效的治疗方法。     

选择性慢径消融治疗房室结折返性心动过速

目的:探讨消融房室结慢径治疗房室结折返性心动过速。方法:对23例住院病人经心内电生理检查确诊为房室结双径路的病进行选择性慢径消融的疗效、复发率及并发症的观察。结果:23例病人心内电生理检查心房刺激均有跳跃现象,A2H2延长均超过50ms。经选择性消融慢径后,术中均成功,但有2例复发,均无房室传导阻滞等并发症的发生。结论:房室结折返性心电过速经选择性慢径消融是安全、可靠、可行的。