射频消融治疗儿童阵发性室上性心动过速

作者采用射频消融法治疗３例预激综合征和１例房室结双径路所引起的儿童顽固性阵发性室上速，全部成功，未发生任何并发症。结果表明射频消融是治疗儿童顽固性阵发性室上速的一种有效的新方法。     

射频导管消融治疗儿童室上性心动过速100例体会

经射频导管消融（ＲＦＣＡ）治疗３．５～１４岁儿童阵发性室上性心动过速（ＰＳＶＴ）１００例，探讨ＲＦＣＡ治疗儿童ＰＳＶＴ的安全性及疗效。１００例中房室折返性心动过速（ＡＶＲＴ）７９例，慢－快型房室结折返性心动过速（ＡＶＮＲＴ）２１例。首次消融成功９６例（９６％）。失败４例均为ＡＶＲＴ。平均Ｘ线曝光时间１９ｍｉｎ。除２例ＡＶＮＲＴ放置导管过程中发生一过性ＩＩ度房室阻滞（ＡＶＢ）外，余术中和术后均无并发症发生。术后随访１个月～４．５年，ＡＶＲＴ复发１例，ＡＶＮＲＴ复发４例（占２１例的１９％），总复发率５％。结论：①ＲＦＣＡ治疗儿童ＰＳＶＴ安全、有效。②因儿童的ＡＶＮＲＴ消融慢径易出现ＡＶＢ且复发率高，应严格掌握手术适应证。③术中Ｘ线曝光时间应＜４０ｍｉｎ。     

儿童室上性心动过速的射频导管消融治疗

随着射频导管消融治疗成年人室上性心动过速（SVT）的极大成功、儿童SVT的消融治疗亦在国内外逐渐开展。目前，国内较大系列的儿童SVT消融治疗的报道不多。射频消融治疗的有效性和安全性等相关问题尚待探讨。     

儿童室上性心动过速的射频消融治疗

采用射频消融(RFCA)治疗成人室上性心动过速(SVT)是一项成功率高、并发症少，较为成熟的技术。但把此项技术应用于儿童患者，其安全性及疗效尚在进一步研究和观察中。因为儿童正处于生长发育段，其适应证、心脏解剖、对X线的耐受性等有其自身特点，现反我院自1995年开展RFCA以来成功消融的12例儿童(年龄≤14岁)患者的资料分析如下。     

射频消融治疗儿童室上性心动过速的应用体会

目的　旨在探讨射频消融(RFCA)在治疗儿童室上性心动过速(SVT)中的应用价值。方法　我院自1998年8月～1999年12月用RFCA治疗小儿SVT共9例,其中男7例,女2例。年龄8～14岁。经检查无器质性心脏病。在骶管或局部麻醉下,经皮穿刺右颈内静脉、股静脉、股动脉插入四极电极导管,先行心内电生理检查明确心律失常电生理机制,后以大头导管精确定位标测,最后从小电能开始RF放电直至有效消融成功。结果　心内电生理检查结果示显性预激综合征6例(3例右侧,3例左侧),右侧隐匿性预激综合征1例,房室结双径路1例,持续性房室交界区反复性心动过速(PJRT)1例。RFCA治疗9例SVT,8例根治,1例复发,无严重并发症发生。结论　RFCA治疗儿童SVT疗效确切,创伤小,可重复应用。对顽固性SVT病儿,需终身服抗心律失常药物及影响儿童学习者通过RFCA可得到根治。然RFCA对幼小婴儿心肌的长远影响尚待积累更多的资料。     

射频消融治疗儿童阵发性室上性心动过速

作者采用射频消融法治疗３例预激综合征和１例房室结双径路所引起的儿童顽固性阵发性室上速，全部成功，未发生任何并发症。结果表明射频消融是治疗儿童顽固性阵发性室上述的一种有效的新方法     

射频消融治疗儿童阵发性室上性心动过速36例临床疗效观察

目的探讨经导管射频消融治疗儿童阵发性室上性心动过速疗效.方法阵发性室上性心动过速患儿36例,年龄7～15岁,平均为6.7±5.3岁,男21例,女15例;经颈内静脉或股静脉置入电生理标测电极行心内电生理检查(EPS),确定阵发性室上性心动过速性质,然后经股静脉或股动脉置入大头消融导管,标测到有效消融靶点进行放电消融.结果36例患儿消融前均诱发出室上性心动过速.确定旁路27例,其中左侧旁路12例,消融成功12例;右侧旁路15例,消融成功14例;房室结双径路9例,消融成功9例.复发4例,再次消融成功,本组手术总成功率97%.术后随访所有患者无消融相关并发症出现.结论射频消融术治疗儿童室上性心动过速是安全和有效的.     

导管射频消融法根治室上性心动过速

射频导管消融治疗预激综合征和房室结双径路并室上性心动过速，具有安全、无痛苦、创伤少、成功率高等特点。资料与方法１一般资料男性１６例，女性５例，年龄最小６岁，最大７１岁，其中１２例为预激综合征（８例Ａ型、４例Ｂ型），９例为房室结双径路。其中７１岁的女病人合并有冠心病、高脂血症；１例６２岁男性为快速房颤经左侧旁道下传，心室率达２５０次／分。所有病人均频繁发作室上速，频率１７０～２５０次／分，有２例病人发作持续数天，药物不能终止。２材料与方法三根６Ｆ４极电极导管（美国Ｄａｉｇ公司产品）从下肢股静脉…     

经导管射频消融治疗小儿室上性心动过速

经导管射频消融 (RFCA)于 1986年成功用于临床房室折返性心动过速 (AVRT)的治疗 ,1991年始国内外广泛应用于临床。目前 ,已成为儿童室上性心动过速 (SVT)的主要根治手段 ,其成功率高 ,安全可靠 ,并发症少 ,复发率低。1　射频能量1.1　射频能量的物理特性　射频电流为一种高频交流电 ,频率范围为 0 .1～ 1.5 MHz。根据其输出形式、电压、波形和功率输出的不同 ,射频电流可达到三种不同的物理效应 :1电切割作用 :射频电流对组织产生电火花和切割作用。 2电凝血作用 :主要是电火花造成组织的炭化及大量凝血。 3电干燥作用 :即低能量的电…     

射频消融治疗老年室上性心动过速

老年室上性心动过速（ＳＶＴ）患者往往合并症多，发作时症状较重，而药物治疗毒副作用较大。射频消融术（ＲＦＣＡ）治疗老年ＳＶＴ是近几年来采用的比较理想的治疗方法，但由于老年人动脉硬化、冠心病、心肌退行性变等基础疾病的存在，给ＲＦＣＡ治疗老年ＳＶＴ带来一定...     

射频消融治疗高龄老年人阵发性室上性心动过速14例

目的探讨射频消融（RFCA）治疗老年人室上性心动过速的有效性和安全性。方法采用常规方法射频消融治疗80岁以上阵发性室上性心动过速（PSVT）患者14例,其中慢径消融治疗房室结折返8例、旁路消融5例、线性消融房扑1例。结果80岁以上的高龄老年PSVT患者14（男11,女3）例,年龄8087（83.7±3.0）岁。主要并发症有高血压病、高脂血症、冠心病、慢性喘息型支气管炎、肺气肿、脑梗死、糖尿病、肥厚性心肌病和主动脉瓣狭窄等。先行冠状动脉造影术4例;髂动脉迂曲,选择对侧动脉或使用长血管鞘跨过迂曲部位消融成功3例;术中发生心衰1例,在导管操作及电生理检查中诱发房颤（AF）2例;主动脉瓣狭窄应用直接穿间隔法后消融1例;在放电时出现Ⅱ度房室传导阻滞1例,放电时出现Ⅰ度房室传导阻滞（PR间期大于0.24 s）2例。穿刺点出现血肿1例。14例患者均首次消融均成功,其中2例复发,再次消融成功。术后共随访624月,均未复发,也无传导阻滞等严重并发症发生。结论射频消融治疗高龄老年人室上性心动过速是有效、安全的。     

Radiofrequency catheter ablation of supraventricular tachycardias in patients with hypertrophic cardiomyopathy

Summary Supraventricular tachycardias, as well as ventricular tachycardia, are critical in patients with hypertrophic cardiomyopathy. Anti-arrhythmic agents often induce arrhythmias, known as pro arrhythmia. Radiofrequency catheter ablation has become a well-established therapy for the treatment of supraventricular tachycardia. The reported success rate is over 90%, although catheter mapping in the left ventricle is difficult in patients with hypertrophic cardiomyopathy because of the marked left ventricular wall thickening associated with bizarre myocardial hypertrophy with disorganization, the abundant capillary muscle networks, and annoying ventricular arrhythmias. This report documents catheter mapping technique of radio frequency ablation in patients with hypertrophic cardiomyopathy and supraventricular tachycardias.     

Radiofrequency catheter ablation for paroxysmal supraventricular tachycardia: a report of 135 procedures

Background: Paroxysmal Supraventricular Tachycardia (PSVT) is a common condition which until recently has been treated with anti-arrhythmic drugs or surgery. Radiofrequency (RF) catheter ablation is a new mode of treatment which provides a cure of this condition. Aims: To present our early experience of RF catheter ablation for PSVT. Methods: One hundred and thirty-five procedures were performed in 117 patients. The diagnostic study and therapeutic catheter ablation were performed as a combined electrophysiological procedure in 74 patients (63%). In 58 patients (50%), PSVT was due to Atrio-ventricular junctional (nodal) re-entrant tachycardia (AVJRT). Twenty-five of the 58 patients underwent a fast pathway ablation while 33 had ablation of their slow pathway. The mean number of radio-frequency pulses delivered was ten for a mean duration of 25 seconds. Radiofrequency ablation of accessory pathways was attempted in 58 patients; pathways were left-sided in 29 patients, postero-septal in 21, midseptal in five, Mahaim connection in two, antero-septal in one and right free wall in one patient. One patient with incessant automatic atrial tachycardia also underwent a successful RF ablation. Results: Using RF ablation cure of PSVT was achieved in 90% of patients. Cure of AVJRT was achieved in 95% (55/58) of patients using either fast or slow pathway ablation. Only one patient required permanent pacemaker implantation for Mobitz type I AV block following fast pathway ablation. The overall success rate for ablation of accessory pathways was 85%. There is an operator learning curve for this procedure suggested by the fact that the success rate for accessory pathway ablation at first attempt was 63% in the first 29 patients and 93% in the remaining 29. There was no significant morbidity or mortality during or after the procedure. In a mean follow-up of nine months in the patients with successful ablation only two patients with AVJRT had a recurrence of documented PSVT. Both these patients had successful repeat RF ablation. Catheter ablation using radiofrequency energy is an effective and safe therapeutic option for patients with symptomatic PSVT. (Aust NZ J Med 1993; 23: 317–324.)     

Radiofrequency catheter ablation of atrial tachycardia

Background: Atrial tachycardia is a relatively uncommon arrhythmia which usually responds poorly to antiarrhythmic drug therapy. Transcatheter radiofrequency (RF) ablation is a new therapeutic modality for patients with atrial tachycardia. Aim: This study analyses our early experience with the treatment of atrial tachycardia by this technique. Methods: Thirteen consecutive patients (age 13–63 years) with 15 drug-refractory atrial tachycardia foci were treated with RF catheter ablation. Atrial tachycardia was mapped by seeking the earliest atrial activation in the right atrium in eight patients and in the left atrium in five. Results: Tachycardias were abolished in nine (69%) patients, including two sinoatrial re-entrant tachycardias and seven automatic atrial tachycardias, after 9±10 (range, one to 28) pulses of RF current. Six of these ablated atrial tachycardia foci were right sided and three were on the left. One patient had three separate right atrial tachycardia foci; one was eliminated. Tachycardia recurred after two weeks in one patient with apparently successful ablation of sinoatrial re-entrant tachycardia. One patient with successful ablation of a right atrial tachycardia developed cardiac tamponade requiring surgical intervention. Conclusion: This study demonstrates that atrial tachycardia arising from diverse sites can be eliminated by RF catheter ablation.     

Radiofrequency catheter ablation of atrial tachycardias related to myocardial scar or incision

Objectives Intra-atrial re-entrant tachycardias(IARTs)are common late after heart surgery.Conventional mapping and ablation is relatively difficult because of the complicated anatomy and multiple potential re-entry loops.In this study we aimed to evaluate the electrophysiological characteristics and radiofrequency catheter ablation of atrial tachycardia(AT)induced by myocardial scar or incision.Methods In 6 patients(three male and three female,aged 33.3±11.8 years)who had AT related to myocardial scar or incision, electrophysiological study and radiofrequency catheter ablation(RFCA)were performed.Earliest activation combined with entrain- ment mapping was adopted to determine a critical isthmus.Results Re-entry related to the lateral atriotomy scar was inducible in 5 of 6 patients.With entrainment mapping,the PPI(post-pacing interval)-TCL(tachycardia cycle length)difference was＜30 ms when pacing at the inferior margins of the right lateral atriotomy scar.Among them,3 patients had successful linear ablation between scar area to inferior vena cava,and 2 patients between scar area to tricuspid annulus.Re-entry involving an ASD patch was demonstrated in 1 of 6 patients.PPI-TCL differences＜30 ms were observed when entraining tachycardia at sites near the septal patch.But linear ablation failed in terminating AT.There was no complication during procedure.No recurrence of AT related to incision was observed during follow-up except for the failed patient.Conclusion Under conventional electrophysiological mapping,adopting linear ablation from scar area to anatomic barrier,successful ablation can be obtained in patients with IRATs related to myocardial scar or incision.     

射频消融术治疗三尖瓣下移畸形并房室折返性心动过速射频消融术治疗三尖瓣下移畸形并房室折返性心动过速

８例三尖瓣下移畸形并右侧旁路患者行射频消融，平均室上速发作病史１１年。成功消融７例共８条旁束。结果表明：射频消融术前先行右室造影有利于消融靶点定位，射频消融术是治疗三尖瓣下移畸形并房室折返性心动过速安全、有效的方法。     

心血管异常患者心动过速的射频消融

目的 :探讨心动过速并发心血管异常时射频消融治疗的安全性和可行性。方法 :对 11例心动过速并发心血管异常的患者 ,做好充分的围术期准备 ,采取合理的治疗策略 ,根据电生理检查结果阻断房室旁路、改良房室结慢径和消除异位起源点分别根治房室折返、房室结折返和房性心动过速。结果 :11例患者 （4例并发血管畸形 ,2例并发凤湿性心脏病 ,3例并发冠心病 ,1例并发尿毒症性心肌病 ,1例为扩张型心肌病妊娠晚期 ）消融均获成功 ,无 1例并发症。结论 :只要治疗策略正确 ,手术准备充分 ,对于心血管显著异常的心动过速患者实施射频消融术同样具有高的成功率和安全性。     

Radiofrequency catheter ablation in recurrent ventricular tachycardia

Catheter ablation by radiofrequency energy was carried out in10 patients with one type of recurrent monomorphic sustainedventricular tachycardia resistant to medical antiarrhythrnicmanagement. Electrophysiological studies before ablation includedactivation and pace-mapping. In all patients, the origin ofthe tachycardia was localized in the left ventricle; in theseptum in six, at the posterolateral wall in three and anterobasalin one. The earliest onset of endocardial activation precedingthe QRS complex during ventricular tachycardia ranged between-45 and -90 ms. Transcatheter ablation was performed with abipolar or quadripolar catheter using a radiofrequency generator(HAT 100, Osypka). No complications occurred during the ablationprocedure. Thereafter, in all patients, the clinical tachycardiawas no longer inducible by programmed stimulation. During afollow-up period of 22 to 32 months including eight patients,the tachycardia recurred in two; one of these patients subsequentlydied suddenly. A third patient had one episode of a new typeof sustained ventricular tachycardia some hours after catheterablation. In the remaining patients, there was no recurrenceof symptctnatic tachycardia under maintainance of the antiarrhythmicmanagement which, prior to ablation had been ineffective. Thus, our preliminary results suggest that radiofrequency catheterablation might be beneficial for these high risk patients.