702例房室结折返性心动过速的射频消融治疗

目的回顾性总结射频消融术治疗702例慢快型房室结折返性心动过速（AVNRT）的疗效及安全性。方法所有病例均先行心内电生理检查,明确诊断后,以中、下位法行射频消融,结合影像学和腔内电图确定靶点。结果本组射频消融成功率99．6％,复发率1．0％,并发症发生率1．3％,无死亡病例。结论射频消融治疗AVNRT成功率高,并发症少,复发率低,以中位法消融、延长单次有效放电时间、消融后房室结不应期延长且达到慢径消失,可有效提高AVNRT的消融成功率,且明显降低术后复发率,寻找有效靶点,细致操作能有效预防并发症发生,心房起搏有一定价值。     

射频消融术治疗房室结折返性心动过速483例临床分析

目的：回顾性分析射频消融术治疗房室结折返性心动过速（AVNRT）483例的疗效及安全性。 方法：所有病例均经心内电生理检查,明确诊断AVNRT后,再分为A组：慢快型、B组：快慢型、C组：慢慢型三型,以中下位法结合电解剖法行射频消融术,统计总的和三组的消融成功率、并发症发生率、死亡率、复发率等。 结果：射频消融术治疗AVNRT总的成功率99．4％,并发症发生率2.27％ ,复发率1.45％,无死亡病例。慢快型、慢慢型、快慢型三型一次成功率无统计学差异,快慢型、慢慢型较慢快型并发症发生率、复发率为高,差异有统计学意义。 结论：射频消融术治疗房室结折返性心动过速总的成功率高,并发症少,复发率低。但快慢型、慢慢型较慢快型并发症发生率、复发率为高,须引起足够重视。     

射频消融术（RFCA）治疗室上性心动过速255例临床研究

目的：对255例阵发性室上性心动过速（PSVT）患者进行分析，探讨射频消融的治疗效果及安全性。方法：回顾性分析255例经导管射频消融治疗PSVT患者的治疗效果，其中房室结内折返性心动过速（AVNRT）119移叶．房室旁道所致房室折返性心动过速（AVRT）122例，房室结双径路合并房室旁道14例。结果：房室结双径路133例（单一房室结双径路119例．合并房室旁道14例），其中慢一快型130例．快一慢型2例．慢一慢型1例；房室旁道122例，其中左侧旁道89例．右侧旁道29例，双旁道4例；房室结双径路合并房室旁道14例，旁道共计140条。成功率98．4％，复发率2．4％，近期并发症2．0％。结论：射频消融术是一种安全、有效的根治室上性心动过速的方法．成功率高．并发症少。     

射频消融慢径路对不典型房室结双径路前传功能的影响

目的:观察不典型房室结折返性心动过速(AVNRT)患者慢径路被消融后对快径路前传功能的影响。方法:38例成功行慢径射频消融的AVNRT患者,其中19例心房刺激均呈连续性AVNFC(甲组);对照组(乙组)19例心房刺激均呈跳跃性AVNFC。比较两组患者慢径射频消融前后的电生理参数变化。结果:消融后两组患者心房递增起搏时最大AH间期(A1H1max)均比消融前显著缩短,乙组A2H2max及ERPAVN-前传有明显变化,而甲组变化不大。结论:房室结双径路是彼此有相互关联的两条径路,与典型AVNRT一样,不典型AVNRT射频消融慢径路后前传功能得到改善。     

经导管射频消融术治疗快速性心律失常

目的：观察我院自开展射频消融术以来对快速性心律失常的射频消融治疗临床疗效与安全性。方法：47例快速性心律失常患者在我院住院行射频消融根治术,对其成功率、并发症、及复发率进行总结分析？结果：47例快速性心律失常患者中,16例房室结折返性心动过速（AVNRT）,14例慢—快型,1例快—慢型,1例慢—慢型;29例房室折返性心动过速（AVRT）,13例左侧旁道,16例右侧旁道,2例室性心动过速（VT）。射频消融成功率95,7％,在术中及术后并发症2,13％,复发率2,13％。结论：经导管射频消融术治疗快速性心律失常患者成功率高,并发症少,复发率低,仍是目前根治快速性心律失常的首选方法。     

房室结慢径消融后食管电生理检查随访(附50例分析)

采用导管射频消融改良房室结治疗房室结折返性心动过速(AVNRT)是众所公认的有效方法.其最常用的是消融慢径路(SP),保留快径路(FP).为了解射频消融改良术后对房室结功能的疗效观察,我们对行射频消融SP的患者进行改良术后食管电生理随访检查,以评价房室结功能.     

房室结慢径消融电生理特性与临床疗效关系探讨

[目的]探讨房室结折返性心动过速(AVNRT)慢径消融时心内电生理改变与临床疗效的关系.[方法]对94例慢-快型AVNRT病人采用射频消融慢径治疗,分析消融前后电生理特征、消融时心内电生理改变和消融终点.[结果]94例均消融成功,其中75例(80%)慢径阻断,19例(20%)慢径未阻断,其中2例(2%)慢径未阻断者并有1～2个心房回波术后随访(28±17)月,4例术后1～5月复发,经再次消融成功.术中5例消融时呈持续交界心律,经消融后仍然有心动过速发作,调整靶点后消融成功;4例放电时有房室传导阻滞先兆,用时间滴定法消融成功.[结论]慢径路消融的理想终点应该是电刺激诱发的心动过速消失;消融时出现持续交界心律是安全的,部分患者需调整消融靶点提高消融成功率;有房室传导阻滞先兆者采用时间滴定法,可避免永久性房室传导阻滞发生.     

房室结折返性心动过速的电生理特征和射频消融

目的　观察房室结折返性心动过速 (AVNRT)的电生理特性 ,探讨AVNRT的消融方法学及疗效判断终点。方法　对 42例AVNRT患者进行射频消融治疗 ,测量术前快经路前传有效不应期 (FERP -B)、术后快经路前传有效不应期 (FERP -A)、术前和术后房室结前传文氏周期 (Wen -AVN)、心房程序刺激最长A2 H2 间期 (AHmax)、心动过速时A2 H2 间期 (AHsvT)及心动过速周长 (CL)。结果　 42例AVNRT患者中 ,慢—快型 40例 ,慢—慢型 1例 ,快—慢型 1例。所有患者消融慢径路后均未诱发AVNRT ,成功率为 10 0 %。消融前后房室结前传文氏周期分别为3 2 9.14± 5 2 .3 4ms和 3 18.47± 46.2 5ms,差异无显著性 (P >0 .0 5 )。消融FERP -B和FERP -A分别为 :3 12 .14± 5 1.3 6ms和 2 67.62± 48.80ms,差异有非常显著性 (P <0 .0 1)。结论　彻底阻断慢径传导 ,可改善房室结传导功能 ,是RF CA治疗AVNRT安全、有效、理想的消融终点。     

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。     

房室结折返性心动过速射频消融出现Ⅰ度房室传导阻滞患者长期预后观察

0 引言射频消融房室结慢径路已成为房室结折返型心动过速(AVNRT)的首选治疗方法,成功率高达90%以上.     

射频消融治疗房室结折返型心动过速

目的：旨在研究和评价射频导管消融治疗房室结返型心动过速的安全性和有效性。方法：病例来源于１９９３年４月至１９９７年４月在心内科住院治疗的心动过速病人，共２８例，男性１５例，女性１３例，年龄１２至６７岁，患者均经心电生理盐证实后行射频导管消融。结果：所有患者经射频导管消融后均获成功，随访３～６个月无１例复发，１例出现Ⅲ度房室传导阻滞，结论：射频过程中出现交界性心律并逐渐减少是成功的征象，消融治疗房室     

射频消融治疗房室结折返性心动过速三例报告

经导管射频消融术（RFCA）治疗3例房室结折返性心动过速（AVNRT）患者。用大头电极导管（Mansfeild/Webester)进行标测和消融，射频电传为4000－16000J。射频消融结果3例均获成功。     

Clinical manifestations and prevalence of different types of supraventricular tachycardia among Chinese.

Sixty-nine cases of paroxysmal supraventricular tachycardia (PSVT) were submitted to electrophysiological studies. The prevalence of different types of PSVT is as follows: 49% of the cases had atrioventricular reentry tachycardia (AV-RT), 14.5% atrioventricular nodal reentry tachycardia (AVN-RT), 28% AV + AVN - RT, and 8.5% other types. Altogether 77% in this group had atrioventricular accessory pathway, of which half are concealed pathway. Electrocardiographic characteristics during tachycardia give hints to diagnosis: (1) AV - RT has the fastest heart rate, with 62% 200 BPM or more, and 82% more than 188 BPM; (2) retrograde P waves can be detected in 64% of cases with AV bypass; (3) 50% of AV - RT shows QRS of bundle branch block pattern. Since accessory pathways are present in the majority of PSVT patients in China, the importance of treatment is stressed.

     

DUAL ATRIOVENTRICULAR NODAL PATHWAYS ASSOCIATED WITH A NODOVENTRICULAR TRACT INSERTING INTO THE LEFT VENTRICLE A CASE REPORT

A patient with recurrent paroxysmal tachycardia of right bundle branch block morphology (RBBBM) and atrioventricular (AV) dissociation is demonstrat ed by electrophysiologic study to have dual AV nodaJ pathways and a unique left sided nodoventricular (NV) tract. Dual AV nodal pathway was manifest in three ways: sudden increment in AV nodal con duction in response to premature stimulation, dou ble ventricular responses to single atrial extrastimuli and alternating fast and slow pathway conduction during right atrial (RA) programmed stimulation or RA overdrive pacing. The A-H interval of the fast pathway was 180 msec and that of the s!ow pathway was 290-330 msec. During RA stimulation, conduc. tion over the slow pathway was associated with marked prolongation of AV conduction, decrease of the H-V interval (0-30 msec) and induction of a QRS morphology similar or identical to that recorded dur ing spontaneous tachycardia. Tachycardia could be initiated by RA stimulation when impulses were conducted over the slow pathway or by right ventri cuk:r stimulation. The variation of QRS duration from 90-125 msec in RBBBM tachycardia indicated that the reentry circuit was confined to the AV node using the slow pathway as the antegrade limb and the fast pathway as the retrograde Iimb and that the anomalous tract was a NV fiber rather than a fascicaloventricular fiber.     

RFCA治疗快速性心律失常的临床分析

目的分析总结经导管射频消融（RFCA）治疗快速性心律失常的疗效,以进一步指导临床工作.方法对我科开展射频消融治疗快速性心律失常15a的工作进行总结,对1847例患者的治疗结果进行回顾性分析.结果房室折返性心动过速（AVRT）患者810例,计有旁道869条,其中左侧旁道532例,右侧旁道278例,其中双旁道15例,房室结双径路合并房室旁道21例.房室结内折返性心动过速（AVNRT）753例.室性心动过速VT和室性早搏（PVT）139例,房性心动过速（AT）29例,心房扑动（AF）32例,心房颤动（A）f84例.射频消融总成功率为97.67%,其中房室结双径路和左侧房室旁道所致的阵发性室上速射频消融成功率高达99%.射频消融术后复发率为2.22%.并发症发生率为3.14%,其中1例患者并发永久性Ⅲ°房室传导阻滞而安置永久性心脏起搏器,无死亡病例.结论射频消融治疗快速性心律失常安全、有效、成功率高、并发症发生率及复发率低.适合于各类人群,以AVRT和AVNRT的疗效最佳.并且能够成为快速性心律失常的治疗首选。     

射频消融术治疗阵发性室上性心动过速210例分析

目的评价射频消融术治疗阵发性室上性心动过速的有效性及安全性。方法对210例阵发性室上速患者采用射频消融术治疗,旁路在心室最早激动点（EVA）或心房最早激动点（EAA）消融,双径路则采用慢径改良。结果射频消融术治疗室上性心动过速的总成功率为97.1%（204/210）,其中旁道参与的心动过速119例,成功率95.0%;房室结折返性心动过速91例,消融成功率为100%。4例（1.9%）患者出现并发症。随访期间,3例（1.4%）患者复发,再次接受射频消融术获成功。结论射频消融术是治疗阵发性室上性心动过速安全及有效的治疗手段,成功率高,并发症少,复发率低。     

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.     

邻近希氏束的快速心律失常的射频消融

目的：探讨邻近希氏束的快速心律失常患者射频消融的策略。方法：对43例邻近希氏束的心动过速患者常规进行电生理检查,明确其机制后采取相应措施进行经导管射频消融术（RFCA）。希氏束旁路的消融在心动过速时进行,而室性心动过速则在窦性心律时消融。记录手术过程、所用器材及并发症发生情况。结果：43例中,10例为希氏束旁路,2例为房性心动过速,30例为房室结折返性心动过速,1例为特发性左心室室性心动过速。首次射频消融成功率为93％(40/43),复发2例,再次消融均成功。30例使用了Swartz R0鞘管。3例房室结双径路患者消融慢径路时出现一过性房室阻滞。结论：邻近希氏束的心动过速射频消融成功率较高,但有一定的特殊性,应采取不同的消融策略,术中尤需避免损伤希氏束。     

房室旁路射频消融治疗室上性心动过速15例

彻底根治房室道引起的房室折返性心动速，并将射频消融技术用于临床。方法采用ＲＦＡ治疗ＡＶＲＴ１５例，其中，左侧旁路１１条，右侧旁路６条，２例合并存在２条旁路。     

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.