导管射频消融治疗房室结折返性心动过速17例特殊病例临床分析

目的分析房室结折返性心动过速（AVNRT）导管射频消融（RFCA）术中出现的几种特殊情况，提高对其认识及消融成功率，减少并发症。方法对射频消融的165例AVNRT患者的电生理、解剖及射频消融放电过程出现的特点等进行回顾性分析。结果17例患者有其特殊性，其中电生理特殊7例，解剖影像异常5例，另有3例在大头电极上有小His电位时进行消融放电，2例在消融放电过程中出现交界性心动过速，2例（同时有影像异常）在冠状窦口下方成功改良慢径者，始终没有出现慢交界区反应。除1例带有小His电位时进行消融的患者于术后2月复发而再次消融成功外，其余16例均一次性消融成功，随访3月～7年无复发，也无并发症发生。结论对AVNRT进行射频消融时出现的特殊情况需仔细分析其电生理机制及解剖学特点，射频消融时密切观察电生理变化和大头电极在心腔的位置，并应根据其各自的特点分别采用不同的射频消融治疗策略，从而提高治疗成功率、减少并发症。

Radiofrequency catheter ablation for treatment of 17 uncommon types of atrioventricular node reentrant tachycardia

Objective To analyze the radiofrequency catheter ablation (RFCA) in treating uncommon types of atrioventricular node reentrant tachycardia (AVNRT),and to increase the recognition and success rate of RFCA as well as to decrease complications.Methods The characteristics of electrophysiology,anatomy and the discharging process of RFCA in 165 AVNRT cases were retrospectively analyzed.Results There were 17 unusual cases,among whom atypical electrophysiological phenomenon occurred in 7 cases,abnormal anatomy and image occurred in 5 cases and radiofrequency discharging was conducted in 3 cases when small His electric potential presented on ablation electrode during ablation procedure.Junctional tachycardia occurred in 2 cases during discharging and slow junctional response was not found at the lower part of coronary sinus ostium of 2 cases.Except that AVNRT recurred in 1 patient 2 months after RFCA because there was small His bundle potential on ablation electrode,the other 16 patients were successfully ablated without complications.3 months to 7 years follow up did not find recurrence.Conclusion In order to get high success rate and decrease complication,it is necessary to pay attention to electrophysiological mechanism and to analyze anatomy and image characteristics carefully,and to closely observe the electrophysiological changes and the special position of large part of electrode in heart.Meanwhile different radiofrequency ablation strategy is adopted according to their specific characteristics.