射频消融术的射频电流对心肌损伤的临床研究

目的：研究射频消融术(RFCA)患术后不同时间血清心肌酶浓度变化及肌酸激酶同功酶(CK—MB)与RFCA诸因素的关系。探讨RFCA对心肌的损伤程度。方法：采用酶连续检测法，分别测定40例阵发性室上性心动过速(PSV丁)患RFCA术前及术后即刻，6、12、24小时血清肌酸激酶(CK)，肌酸激酶同功酶(CK—MB)及天冬氨酸氨基转氨酶(AS丁)的浓度。结果：RFCA患CK，CK—MB，AS丁均于术后即刻升高，术后6小时达到峰值．12小时下降，24小时除CK外，均恢复正常(P均＜0．05)。经相关分析表明CK。MB活性变化的峰值升高程度与消融时间，平均功率及累计能量均无线性关系(r＝0．14，r＝0．19，r＝0．27，P均＞0．05)，而与消融靶点个数高度正相关(r＝0．84，P＜0．001)，与消融次数也有显关系(r＝0．52，P＜0．01)。结论：RFCA对心肌组织确有不同程度的损伤，但持续时间短，损伤轻，恢复快。这提示RFCA系安全有效的治疗快速心律失常的方法。

Clinical study about myocardial injury after radiofrequency catheter ablation

Objective: To study the relationship among myocardial injury and changes of aspartate aminotransferase (AST), serum creatine kinase (CK) and MB of CK (CK-MB) levels in patients with paroxysmal supraventricular tachycardia (PSVT) undergoing radiofrequency catheter ablation (RFCA). Methods: The levels of AST, CK, CK-MB were measured before, immediately after ablation and every 6 hours thereafter for 24 hours to detect myocardial injury in 40 Patients with paroxysmal supraventricular tachycardia (PSVT). Results: The levels of AST, CK, CK-MB significantly increased immediately after ablation than those of before ablation in undergoing radiofrequency catheter ablation (RFCA) patients and those parameter were supreme after 6 hours, decreased after 12 hours and regained normally after 24 hours but CK. The analysis of liner correlation showed that the levels of serum CK-MB positively correlated with number of ablation site (r = 0. 84, P<0.001) and ablation frequency (r=0. 52, P< 0.01), not correlated with ablation time, average power and accumulative energy (r=0.14, r=0.19, r=0. 27, P > 0.05). Conclusion: Radiofrequency catheter ablation (RFCA) for paroxysmal supraventricular tachycardia (PSVT) indeed cause some miner myocardial injury, measurement of the CK-MB may be useful to detect myocardial injury in ablation patients with paroxysmal supraventricular tachycardia (PSVT).