预激综合征伴房颤射频消融治疗的探讨

目的观察房室旁路射频消融术与房室旁路射频消融联合环肺静脉电隔离术两种消融方法治疗预激综合征伴心房颤动患者的疗效。方法本研究纳入58例预激伴房颤患者,随机分为两组,一组为单纯行房室旁路射频消融术(单纯组)36例,另一组为房室旁路射频消融术联合环肺静脉电隔离术(联合组)22例,术后随访两组患者房颤的复发情况。结果最长随访42个月,最短随访3个月,两组随访期间均无一例患者发生房颤(p>0.05),差异无统计学意义。结论在预激伴房颤患者中,房室旁路射频消融联合环肺静脉电隔离术不优于单纯房室旁路消融术;房室旁路消融术可减少预激伴房颤患者的房颤再发率。     

房颤伴长R-R间歇患者射频消融1例术后观察

心房颤动(房颤)是最为常见的心律失常之一,房颤的发病率随年龄增长而增高.流行病学研究发现,房颤在正常人群的发病率为0.15%～2.3%,65岁以上为3%～5%,而到75岁时可高达15%.在我国35岁以上人群中房颤患病率为0.61%,推测在13亿人口的中国人群中,患者约800万[1].     

射频消融治疗房颤现状

心房颤动 ( AF)是常见的心律失常 ,指过快而极不规则的心房异位搏动 ,频率常为每分钟 350～ 60 0次。其本身可引起心脏结构与功能的变化 ,恶化血流动力学状态 ,严重影响患者生活质量并危及生命。因而其防治突出的成功研究热点与难题。药物治疗是目前临床治疗的主要手段 ,但长期药物治疗难免发生毒副反应 ,患者的依从性亦有限。射频消融 ( Ra-diofrequency ablation;RFA)是近十年兴起的一种新的 AF治疗手段。本文主要就其现有的几种消融治疗方法作一简述。1　房室交界区射频消融房颤时 ,心功能受损的机制主要是左房功能与左室功能改变。…     

CRT伴频发室早的射频消融疗效

目的回顾性研究射频消融治疗心脏再同步化治疗术后频发室性早搏的可行性和安全性。方法本中心5例心脏再同步化治疗（CRT）术后患者,24h动态心电图提示室性早搏负荷大于总心率的10%,给与心内电生理检查和射频消融术。结果 5例患者男性4例,女性1例,平均年龄48±13.43岁。4例患者被成功消融,即刻成功率为80%;随访12个月4例均无复发。4例成功消融患者随访6个月较术前比较,左心室射血分数（LVEF）明显增加（31.05±3.50%vs.23.00±2.94%,p〈0.05）、左室舒张末期内径（LVEDD）明显减小（60.50±5.06mm vs.68.00±6.37mm,p〈0.05）、左室收缩末容积（LVESV）明显减小（127.32±28.09vs.186.75±40.90,p〈0.05）。另1例患者术前和术后,各心脏超声参数无明显变化。无一例出现并发症。结论射频消融是一种有效的治疗CRT术后频发室性早搏的方法,同时也可以改善CRT术后无反应者疗效。     

房颤射频消融的进展和挑战

导管射频消融是近二十年来房颤研究领域进展最快,也是最有希望根治房颤的方法。多项临床研究显示,在窦律维持、生活质量等方面,导管消融治疗房颤优于抗心律失常药物治疗。导管消融的经历了多种术式,基本上可以分为两类：一类是以肺静脉为主要靶点的术式,包括肺静脉点消融、环形消融、肺静脉节段性电隔离和环肺静脉电隔离等;另一类是不以肺静脉为主要靶点的术式,包括神经节丛消融、复杂碎裂心房电位（CFAE ）消融、转子（rotor）消融等。     

房颤与房扑的射频消融治疗研究

目的 探讨房颤与房扑之间的相互关系，寻找房颤的射频治疗方法。方法 对40例阵发性房颤患者进行了电生理标测及射频消融。结果 40例中有6例患者发生房扑，行右房峡部消融，1例行Halo电极标测示峡部双向阻滞，随访12－30个月房颤消失或次数明显减少。结论 房颤与房扑为两种密切相关的心律失常，消融右房峡部可能对部分房颤患者起到治疗作用。     

双房心外膜射频消融治疗房颤的临床经验

迷宫手术及改良术式治疗房颤效果确切,但迷宫手术由于增加手术时间和死亡率,难以广泛使用。由于射频凝固(RFC)的热能可较迅速地在心肌产生损伤并造成传导阻滞,该研究探讨采用双房心外膜射频消融法治疗无二尖瓣疾病的     

风湿性心脏病合并房颤患者实施Atricure双极射频消融的疗效

目的:探讨风湿性心脏病合并心房颤动(AF)患者实施Atricure双极射频消融治疗的临床疗效及安全性。方法:选择2015年4月～2016年4月我院收治的90例风湿性心脏病合并AF患者为研究对象。所有患者均行瓣膜置换术,根据射频消融(RFA)方式不同,患者被分为双极RFA组(接受Atricure双极RFA治疗,45例)与单极RFA组(45例)。观察并比较两组术中主动脉阻断时间、转流时间,手术相关并发症发生情况,术后房颤转复率及心功能变化。结果:与单极RFA组比较,双极RFA组的主动脉阻断时间[(78.12±23.42)min比(65.03±21.37)min]、转流时间[(164.59±50.74)min比(115.37±36.45)min]均显著降低(P=0.007,0.001)。双极RFA组无手术相关并发症发生,而单极RFA组术后有4例患者需植入永久起搏器。双极RFA组术后1、3、6个月房颤转复率均显著高于单极RFA组(86.67%比68.89%,91.11%比71.11%,93.33%比77.78%),P均0.05。术后6个月,与单极RFA组比较,双极RFA组的左室射血分数[(53.29±6.91)%比(56.47±7.84)%]显著升高(P=0.044)。术后1年,与单极RFA组比较,双极RFA组的房颤转复率(71.11%比88.89%)、LVEF [(54.27±6.32)%比(59.03±7.02)%]均显著升高(P=0.035,0.001),而LVEDd[(51.38±9.16)mm比(47.42±8.31)mm]则显著减小(P=0.034)。结论:实施Atricure双极射频消融治疗风湿性心脏病合并心房颤动短期疗效确切,安全性更高。     

房室结内折返性心动过速慢径路消融中房室传导阻滞的预防

目的 探讨房室结内折返性心动过速(AVNRT)慢径路消融中房室传导阻滞的预防措施。方法 72例AVNRT患者从小功率(5W)开始放电，逐步增加放电功率，根据放电时的反应，及时改换安全的放电部位；放电过程中不苛求房室交接区心律从有到无的规律；慢径路改良，不苟求慢径路消失，以不诱发心动过速为宗旨。结果 72例慢径路消融均成功，无一例发生房室传导阻滞的并发症，无一例远期复发。结论 从小功率开始放电，慢径路改良等措施，可有效预防房室传导阻滞，且对远期复发无影响。     

射频消融治疗儿童房室结折返性心动过速的体会

目的　讨论射频消融术 (RFCA)治疗儿童房室经折返性心动过速的体会。方法　 1992年 3月至 2 0 0 1年 12月 ,应用射频消融术 (RFCA)治疗儿童房室结折返性心动过速共 5 2例 ,男 3 0例 ,女 2 2例 ,平均年龄 (8 4± 3 2 )岁 (3 5～15岁 )。全部病例均行食道心房调搏术及心内电生理检查 ,选择消融慢径路。结果　食道心房调搏术S2 R跳跃延长(63 1± 10 3 )ms(5 0～ 110ms) ,心内电生理检查AH跳跃延长 (5 2 4± 15 8)ms(3 0～ 10 5ms)。总消融成功率 97 6% ,输出功率 (18 2± 3 2 )W ,放电次数 (12 1± 4 2 )次 ,手术时间(1 5± 0 5 )h ,X线曝光时间 (18 5± 5 4)min。结论　射频消融术治疗儿童房室结折返性心动过速是安全、有效的 ,但应严格掌握适应证     

房室结折返性心动过速射频消融术后复发机制探讨

目的: 探讨房室结折返性心动过速射频消融术后复发原因。方法: 对356 例房室结折返性心动过速患者射频消融术后进行随访,回顾性分析其电生理资料。结果: 356例中10例复发,复发率2.8%,320例患者射频术后无心房回波,无跳跃现象,一直未复发;术后有心房回波无跳跃现象未诱发出室上速17例,其中3例复发;术后有跳跃及心房回波未诱发出室上速11例,其中5例复发;术后有跳跃无心房回波未诱发出室上速8例,2例复发。10例复发患者,第2次射频消融术后房室结不应期均较第1次术后延长,且与术前快径不应期差值明显减小,第2次射频消融术后随访至今（>9个月）,无1例复发。结论: 慢径残存是房室结折返性心动过速射频消融术后复发的主要原因。     

多种类型房室结折返性心动过速的电生理特点

目的 探讨多种类型房室结折返性心动过速（AVNRT）的电生理特征及消融体会。方法 回顾性分析成功行射频导管消融的113例AVNRT病人的临床和心内电生理资料。结果 113例AVNRT患者中6例存在多种类型AVNRT,其中存在2种、3种和4种类型AVNRT者各占2例,共有8种类型AVNRT;2例存在MAVNP,其余4例DAVNP阳性;均在慢径路区域行射频消融,放电时出现交界性早搏和/或心律,放电次数,功率、时间和X线曝光时间与同期慢-快型AVNRT相似,术后应用阿托品或异丙基肾上腺素未再诱发室上性心动过速,亦无回波,术中和术后均无房室传导阻滞,随访2.0-25.5月,无1例复发。结论 多种类型AVNRT并不少见,中径路既有逆传功能,也具有前传功能,多种类型AVNRT的射频消融类似于慢-快型AVNRT,安全有效。     

儿童房室结折返性心动过速患者经冷冻消融和射频消融的结果比较

目的 比较经导管冷冻消融和射频消融治疗儿童房室结折返性心动过速（AVNRT）的临床效果。方法 73例年龄在18岁以下，诊断为AVNRT的患者入选本研究，根据治疗方法分为冷冻消融组（冷冻组）和射频消融组（射频组），记录并分析比较两组的临床特点、冷冻标测次数、消融次数、X线曝光时间、消融术总时间、成功率、并发症发生率以及复发率。结果 共73例患者入选，冷冻组33例，男性16例，女性17例，平均年龄（12．4±2．8）岁；射频组40例，男性18例，女性22例，平均年龄（13．6±2．2）岁。冷冻组和射频组的消融次数分别为（2．7±1．7）次和（11±6．3）次（P〈0．001），X线曝光时间分别为（20±7）min和（25±9）min（P〈0．05），消融术总时间分别为（214±33）min和（164±36）min（P〈0．05），消融成功率88％（29／33）对100％（40／40）（P〈0．01），一过性房室阻滞的并发症发生率为12％对2．5％（P〈0．01）。冷冻组所有术中发生的传导阻滞均在5min内恢复。两组的复发率差异无统计学意义（6％与2．5％，P=NS）。结论 经导管冷冻消融治疗儿童AVNRT安全有效，但成功率低于射频消融，目前可作为后者的一种补充。     

Successful radiofrequency catheter ablation of atrial muscle reentry tachycardia in a young adult

Atrial muscle reentry as a mechanism of tachycardia has been well illustrated in isolated animal atrial muscle. It has infrequently been reported as an etiology of supraventricular tachycardia in young patients. A case of atrial muscle reentry tachycardia and its successful elimination using radiofrequency catheter and its successful elimination using radiofrequency catheter ablation is reported.     

Catheter ablation of accessory pathways and atrioventricular nodal reentry tachycardia

Radiofrequency current catheter ablation has gained acceptance as primary long-term therapy for patients with symptomatic accessory pathways and symptomatic atrioventricular nodal reentrant tachycardia (AVNRT) with frequent recurrences. In both arrhythmias, curative treatment is possible in more than 90% of cases at a low complication rate although an incidence of about 1% complete AV block after slow pathway ablation has to be taken into account when this therapy is considered. The recurrence rate is 3-10% for accessory pathways and 0-15% for AVNRT. The high success rate of catheter ablation has already led to a shift in the indications for the procedure where the percentage of patients with accessory pathways is decreasing and there is an increase of patients with AVNRT and newer indications (atrial flutter, focal atrial tachycardias).     

Atrioventricular nodal reentry tachycardia in children: curative treatment by high frequency catheter ablation

BACKGROUND: Atrioventricular nodal reentrant tachycardia (AVNRT) is one of the most common forms of supraventricular tachycardia in the pediatric population. PATIENTS AND METHODS: 41 children with a mean age of 9.6 (3.7-16) years with recurrent atrioventricular nodal reentrant tachycardia (AVNRT) refractory to medical treatment (n = 38) and recurrent syncope (n = 3) underwent electrophysiologic (EP) study. In all patients dual AV-nodal physiology could be demonstrated during EP study and typical form of AVNRT (mean heart rate 220/min) could be induced by programmed atrial stimulation. A steerable 7 F ablation catheter was placed at the inferoparaseptal region of the tricuspid valve annulus close to the orifice of the coronary sinus with the intention to record a late fractionated local atrial electrogram during sinus rhythm. Starting at this point radiofrequency current (500 kHz) with a target temperature of 70 degrees C was delivered with the intention to ablate the slow pathway. If a slowly accelerated junctional rhythm (< 120/min) occurred during energy discharge, programmed atrial stimulation was repeated. Otherwise radiofrequency current was delivered step by step up to a septal position next to the tricuspid valve annulus. Slow pathway ablation was defined as lack of evidence of dual AV nodal pathways during repeated atrial stimulation. Slow pathway modulation was defined as maximal one atrial echoimpulse after ablation. RESULTS: The number of energy applications ranged from 1-19 (median 6). In 35/41 patients slow pathway ablation could be achieved; in six patients the slow pathway was modulated. In none of the patients permanent high grade AV block was observed. During follow-up (mean 4.1 years) two patients had a recurrent episode of AVNRT after slow pathway modulation. All other patients are still free of AVNRT without medical treatment. CONCLUSION: Selective radiofrequency current ablation/modulation of the slow pathway is a safe and curative treatment of AVNRT in young patients.     

Comparison of remote magnetic versus manual catheter navigation for ablation of atrioventricular nodal reentry tachycardia

Objective The purpose of this study was to compare remote magnetic catheter navigation with manual navigation for the ablation of atrioventricular nodal reentry tachycardia （AVNRT）. Methods From November 2007 to November 2009, 30 consecutive patients with AVNRT received radiofrequency ablation in the Institute of Geriatric Cardiology. Of them, 14 were treated with remote magnetic navigation （RMN） and 16 with manual catheter navigation （MCN）. Total fluoroscopic time,procedure time, procedural success rate, and complication rate were compared between the two groups. Results Total fluoroscopy time and precise orientation time were reduced in RMN group compared to MCN group （7.5＋0.3 min vs 13.9~5.3 rain, and 1.0-x-0.3 min vs 3.2：~0.6 min, respectively, both P〈0.05）. Procedural success rates in both groups were 100% and no AVNRT recurred in all patients during 3 months＇ follow-up. The number of lesions delivered was less for RMN group （3.4~1.1 vs 6.3＋2.2, P〈0.05）. Total procedure time （25.6~7.5 rain vs 27.5a：6.2 rain,/〉〉0.05） was similar between the 2 groups. No procedural complications occurred in both groups. Conclusions RMN for mapping and ablation of AVNRT significantly reduce precise orientation time, total fluoroscopy time and number of lesions delivered compared to the conventional technique of manual steering of deflectable catheters. Remote magnetic control mapping and ablation of AVNRT is more safe and feasible （J Geriatr Cardio12010; 7：7-9）.