线性消融治疗房室结折返性心动过速消融后复发疗效观察

目的:比较房室结折返性心动过速(AVNRT)消融术后复发线性消融与常规方法消融的有效性和安全性。方法:回顾性分析AVNRT消融术后复发Koch三角基底部线性消融19例,与常规方法消融29例的慢径消除率、手术成功率、放电时间和操作时间。结果:线性消融放电时间明显长于常规方法消融,而慢径消融率、手术成功率及操作时间差异均无统计学意义。两组在消融过程中,各有1例出现一过性Ⅰ度房室传导阻滞。结论:对于常规方法消融后复发的AVNRT患者,Koch三角基底部线性消融及常规方法消融均安全、有效,两者可互为补充。     

经导管射频消融治疗阵发性室上性心动过速的临床疗效观察

目的:探讨阵发性室上性心动过速患者经导管射频消融术治疗后的临床效果.方法:56例阵发性室上心动过速患者,常规行心腔内电生理检查明确室上性心动过速类型.左侧房室旁道参与的折返性心动过速消融时采用主动脉瓣逆行途径或穿刺房间隔途径标测和消融,右侧房室旁道参与的折返性心动过速经右股静脉标测和消融,房室结折返性心动过速消融采用下位法消融慢径路.结果:56例阵发性室上性心动过速(PSVT)患者中房室结折返性心动过速39例(69.6％)、房室折返性心动过速17例(30.4％),其手术即时成功率为96.4％(54 /56),平均手术时间为(108.6±20.5) min,术后复发率1.8％(1 /56).56例患者中出现手术并发症2例(3.6％),其中1例出现短暂性可逆性Ⅲ度房室传导阻滞,其余患者均无瓣膜损伤、心包填塞和死亡等严重并发痘.结论:经导管射频消融治疗阵发性室上性心动过速是安全有效、成功率高、并发症少的方法.     

国产三维电解剖标测系统导引房室结折返性心动过速经导管射频消融的临床研究

【摘要】 目的 评价国产Columbus三维电解剖标测系统导引房室结折返性心动过速（AVNRT）经导管射频消融（RFCA）治疗的安全性和有效性。方法 回顾性分析2016年1月至2018年2月在郑州大学附属洛阳中心医院确诊为AVNRT并接受RFCA治疗患者160例,分为传统二维消融组（n=100）和国产三维消融组（n=60）。比较两组患者手术时间、X 线曝光时间、放电消融时间、即刻消融成功率、并发症发生率、术后 1年心动过速复发率。 结果 两组患者手术即刻成功率均为100%。国产三维消融组手术时间稍长于传统二维消融组［（65.5±14.7） min对（58.4±11.3） min,P＜0.05］,X 线曝光时间显著缩短［（3.5±2.4） min对（15.3±1.8） min,P＜0.05］;两组放电消融时间差异无统计学意义［（160±35） s对（180±20） s,P＞0.05］,并发症发生率、1年复发率差异均无统计学意义。 结论 国产Columbus三维电解剖标测系统导引RFCA治疗AVNRT可明显缩短X线曝光时间,安全有效。由于初期应用Columbus系统,整体手术时间可能略长。     

西宁地区快速心律失常的临床特征及射频消融治疗

目的:分析西宁地区射频导管消融(RF-CA)治疗快速性心律失常的疗效及安全性。方法:根据体表心电图和心内电生理检查结果,应用射频导管消融术(RFCA)治疗快速性心律失常患者1 174例,其中房室折返性心动过速(AVRT)670例(单条旁道中,左侧旁道590例,右侧旁道52例;多条旁道28例),房室结折返性心动过速(AVNRT)462例,AVRT合并AVNRT 4例,特发性室性心动过速(IVT)26例,房速5例,典型房扑7例。结果:第一次消融成功率为96.5%,未成功者或复发者在第二次消融后总成功率为98.9%,其中AVRT总成功率为99.4%,AVNRT总成功率为99.2%,IVT总成功率为96.2%,房速总成功率为60.0%,典型房扑总成功率为71.4%;总复发率为1.2%。未出现二度以上房室传导阻滞及心包填塞等并发症。结论:RF-CA是根治快速性心律失常的有效方法,成功率高,且安全性好。     

探讨激动标测联合窦律下射频消融术治疗左后分支型室性心动过速的疗效

 目的 探讨心动过速下激动标测联合窦性心律下射频消融治疗左后分支型室性心动过速(left ventricular posterior fascicular tachycardia, LVPFT)的临床疗效。方法 2016-10至2018-09在武警特色医学中心就诊的LVPFT患者6例,男5例,女1例,年龄18~33岁,平均(24.4±5.8)岁,无器质性心脏病证据。采用Carto-3系统,窦性心律下构建室间隔左后分支区域。诱发心动过速后在左后分支区域激动标测最早V波。终止室速,窦性心律下于最早V波附近标测并消融碎裂浦肯野电位(Purkinje potential,PP)至消失。在该消融点近基底段约1 cm左右处,再次标测正常PP电位并消融至消失,或体表ECG下壁导联呈qR型。结果 6例手术全部成功,手术时长(117.5±15.1)min,X线剂量(77.5±32.9)mGy,平均消融(6.5±1.5)次,消融时间(4.7±1.5)min,无严重并发症。术后随访6~30个月,平均(16.5±8.4)个月,无心动过速复发。结论 激动标测联合窦性心律下射频消融治疗LVPFT的方法,初步研究显示治疗靶点指向性强,安全有效,具有临床实用性。     

CARTO电解剖标测系统指导下射频消融房室结折返性心动过速

目的评价CARTO电解剖标测系统对射频消融房室结折返性心动过速(AVNRT)的指导作用。方法将20例阵发性室上性心动过速患者分为CARTO组(在ARTO指导下行射频消融)和对照组(在常规X线下行射频消融)。比较两组标测与消融过程的X线曝光时间、手术时间、放电次数、放电时间及并发症发生情况。结果20例均即时消融成功。CARTO组与对照组比较,手术时间无显著性差异(105.8±23.8minvs117.1±21.6min,P>0.05),X线曝光时间明显缩短(6.3±2.6minvs16.2±7.0min,P<0.05),放电次数显著减少(2.7±1.5vs5.8±2.4,P<0.05),放电时间显著缩短(173.2±80.5svs355.8±96.4s,P<0.05);术中及术后无一例出现房室传导阻滞,随访6～9个月无心动过速复发病例。结论在CARTO电解剖标测系统指导下射频消融AVNRT安全有效,较常规X线透视下标测定位准确可靠,可减少放电次数,缩短X线曝光时间。     

室上性心动过速并器质性心脏病的射频消融

目的　报道 37例室上性心动过速并器质性心脏病的患者射频消融的疗效及安全性。方法　1993年至 2 0 0 3年 10年间我院射频消融治疗室上性心动过速近千例患者中 ,37例同时合并有器质性心脏病 ,男 2 0例 ,女 17例 ,年龄 12± 76岁 (平均 4 7± 15岁 ) ,均有反复发作心动过速病史多年。其中瓣膜病 4例 ,先天性心脏病 5例 ,高血压心脏病 17例 ,心肌病 3例 ,冠状动脉粥样硬化性心脏病 3例 ,病态窦房结综合征 (SSS) 4例 ,肺心病 1例。射频消融方法 :常规行左右股静脉、左锁骨下静脉穿刺 ,必要时颈内静脉穿刺 ,放置电极导管至冠状窦 (CS)、高右房 (HRA)、右心室 (RV)及希氏束 (His)位置。根据患者病情 ,高血压患者先控制好血压 ,有心功能不全者术前将心功能纠正为I -II级。术中根据情况 ,决定先行射频消融还是先纠正某些基础心脏病 ,由旁路参与的心动过速患者 ,尽量少诱发心动过速 ,以免诱发心功能不全。结果　 37例患者 36例 1次消融成功 ,1例首次消融失败第 2次手术成功 ,2例复发 ,经再次手术成功。其中房室结折返性心动过速 14例 ,房室折返性心动过速 2 1例 (显性旁路 7例 ) ,多径路 2例。 3例二尖瓣狭窄患者 ,2例先行二尖瓣球囊扩张术 ,1例因发作频繁先行射频消融术。 2例房间隔缺损和 3例动脉导管未闭者先     

射频消融治疗阵发性室上性心动过速体会

射频电流导管消融 (RFCA)治疗阵发性室上性心动过速 (PSVT)具有较安全、不开刀、损伤小、一次性根治等诸多优点 ,已被众多患者接受。本文结合 2 5例PSTV消融治疗的经验 ,浅谈自己的体会。对象与方法一、病例选择2 5例PSTV患者接受RFCA治疗。男 15例 ,女 10例。年龄 12～ 6 0 (平均 4 2± 11)岁。PSTV病因 :①旁道 (AP) 19例 ,其中隐匿性AP9例 ,显性AP 10例。②房室结折返性心动过速(AVNRT) 6例。二、RFCA按常规方法进行。三、所有RFCA患者均在门诊或经通信随访 ,复发者免费再次接受RFCA治疗。结果一、成功率2 5例患者接…     

导管射频消融治疗飞行员快速心律失常临床分析

目的探讨导管射频消融（RFCA）在治疗飞行员多种快速性心律失常中的安全性及临床应用价值，探讨飞行员快速性心律失常的航空医学鉴定标准。方法对13例快速性心律失常的飞行员进行了电生理（EP）检查，特发性室性心动过速（VT）1例，频发室性期前收缩（VE）2例，阵发性心房纤颤（AF）1例，房室折返性心动过速（AVRT）5例，房室结折返性心动过速（AVNRT）3例，房性心动过速（AT）1例。对其中12例采用RFCA治疗。结果RFCA即刻成功率为100％，全组无并发症发生。1例房性心动过速未行导管射频消融治疗。所有飞行员术后地面观察6个月后，返院进行随访复查，同时进行飞行鉴定。12例导管射频消融治疗，术后6个月24h动态心电图、12导联心电图检查和食道电生理检查均未检测到术前的同型快速性心律失常发作，延迟成功率为100％，医学鉴定合格。1例AT仍有发作，飞行不合格。结论对于飞行员快速性心律失常进行导管射频消融治疗是一种安全、有效的治疗方法。心脏电生理检查应作为飞行员快速性心律失常医学鉴定的主要指标之一。     

导管射频消融治疗房性心动过速39例

目的　探讨房性心动过速 (房速 )的电生理检查和射频消融方法及疗效。方法　 39例房速患者进行了电生理检查和射频消融治疗 ,房速病史 (4 .5± 1.6 )年。合并房间隔缺损 2例 ,冠心病 1例 ,皮肌炎 1例 ,其余均无器质性心脏病。房速发作时采用激动顺序标测法确定心房最早激动点(EAA)。结果　 3例房速为房早诱发 ,其余均为心房电刺激诱发并可终止。有 9例同时伴发其他心动过速 ,其中 5例房室结折返性心动过速、2例房扑、2例旁道。房速时标测到EAA ,并消融成功的部位确定为房速起源部位 ,33例成功病例起源部位为冠状静脉窦口附近 9例 ,靠近希氏束部位 5例 ,沿终末嵴分布于右房侧壁 13例 ,上腔静脉 2例 ,房间隔 3例 ,右上肺静脉 1例。房速消融成功率 81% (33/39) ,9例合并的其他心动过速也均消融成功 ,术中和术后无并发症。X线透视时间为 (16 .4± 2 .1)min。结论　导管射频消融可以根治房性心动过速 ,疗效好、安全性高 ;激动顺序标测是最有效的标测方法 ;房间隔及终末嵴是房速的好发部位     

射频消融术在快速心律失常中的临床应用

目的评价射频消融术治疗快速心律失常的临床疗效及安全性。方法分析我院施行射频消融术的19例快速心律失常病例的电生理特性、手术成功率和并发症。结果19例快速心律失常中,房室结折返性心动过速（AVNRT）8例;房室折返性心动过速（AVRT）10例,隐性旁道7例,显性旁道3例;左侧旁道8例,右侧旁道2例;双旁道1例;房速1例。经射频消融均获成功,无明显并发症。结论经导管射频消融治疗快速心律失常成功率高,且安全可靠,为目前治疗快速心律失常的首选方法。     

Carto3三维电生理标测在阵发性室上性心动过速射频消融术中应用的初步研究

目的 评估Carto3三维电生理标测系统导引下施行阵发性室上性心动过速(PSVT)射频消融(RFA)术的可行性、有效性及安全性.方法 回顾性收集2015年3月至2016年2月接受Cano3三维电生理标测系统导引下RFA治疗的28例PSVT患者(Carto组),2014年3月至2015年2月接受X线导引下RFA治疗的36例PSVT患者(X线对照组),对比两组术中X线辐射时间、手术成功率、手术时间、并发症及复发率等差异.结果 Carto组术中X线辐射时间(2.6±2.3) min,显著低于X线组(15.8±9.5) min(P＜0.001),其中8例房室结折返性心动过速(AVNRT)患者零X线辐射.Carto组、X线组手术功率分别为28/28(100％)、35/36 (94.4％) (P＞0.05),手术时间分别为(162.7±34.4) min、(149.4±46,2) min(P＞0.05).Carto组无并发症发生,X线组1例AVNRT患者消融中出现一过性Ⅱ°房室传导阻滞.随访6个月,两组均无复发患者.结论 Carto3三维电生理标测系统导引下PSVT RFA安全有效,显著降低X线辐射时间,部分AVNRT患者可实现零X线辐射,不增加手术时间及手术风险.     

单导管法射频消融单形性右室流出道室性早搏、室性心动速（附80例）

目的：评价单导管法消融单形性右室流出道室早、室速的有效性、安全性和实用性。方法：对62例心脏结构正常的右室流出道单型性室早及18例右室流出道单型性室速进行了单导管射频消融。采用起搏标测法,以起搏时与室早或室速波形态完全相同点为消融靶点。结果：80例室早或室速均起源于右室流出道,呈完全性左束支阻滞形态。消融即刻成功率93.7%（75/80）,未成功的5例改为在CATO三维标测系统下消融成功,动态心电图记录消融前后室早数为（14563±2453）次/24h和（586±158）次/24h,有1例患者出现心包填塞,经穿刺置管引流后消失。随访期间有5例复发,再次用单导管法射频消融成功。结论：经单导管射频消融可有效而安全地消融心脏结构正常的右室流出道单形室早、室速,可作为症状严重、药物治疗无效或不能耐受患者的治疗选择,并且手术时间短、并发症少、大量节省费用、技术易掌握。     

Using multidetector CT for preoperative vascular evaluation of liver neoplasms: technique and results

OBJECTIVE: We evaluated the feasibility, tolerance, and efficacy of percutaneous hepatic vein or segmental portal branch balloon occlusion during radiofrequency ablation of hepatic malignancies. SUBJECTS AND METHODS: Ten tumors were treated by percutaneous radiofrequency ablation during balloon occlusion of a hepatic vein (n = 8) or a segmental portal branch (n = 2). Venous occlusion was undertaken because the tumor was in contact with a hepatic vein (n = 3) or a portal branch (n = 1); because the tumor exceeded 35 mm in width (mean, 44 mm), which was considered the maximum size amenable to ablation in a single session (n = 2); or because of both large size and contact with a hepatic vein (n = 3) or a portal branch (n = 1). RESULTS: Vascular occlusion was always technically possible. Radiofrequency was delivered to one to three locations (mean, 1.9 locations) with a cluster electrode. The largest axis of radiofrequency-induced lesions after ablation with the cluster needle-between 42 and 51 mm (mean, 49 mm)-was always larger than the targeted tumor. These sizes were statistically larger than in a matched control group of patients who underwent radiofrequency ablation without vascular occlusion (p < 0.0003). After a mean follow-up of 12.6 months, CT and MR imaging revealed complete destruction of nine tumors after a single radiofrequency ablation treatment; one tumor required three treatments to achieve ablation. Five patients are tumor-free 12-18 months (mean, 14.4 months) after the first radiofrequency ablation treatment, and five developed new liver metastases. CONCLUSION: Temporary hepatic vein or portal branch occlusion during radiofrequency ablation can safely facilitate the treatment of large tumors or tumors in contact with the walls of large vessels.     

Power rolloff during interactive radiofrequency ablation can enhance necrosis when treating hepatocellular carcinoma

OBJECTIVE: The purpose of this study was to compare the efficacy between standard and interactive radiofrequency ablation for treatment of hepatocellular carcinoma. SUBJECTS AND METHODS: Of 97 patients with 112 nodular hepatocellular carcinomas, 59 hepatocellular carcinomas were ablated using a standard algorithm and 53 hepatocellular carcinomas, using an interactive algorithm. For the procedure using the interactive algorithm, the electrode's array was partially retracted or fully deployed depending on the change of impedance. Complete tumor necrosis was defined as the lack of enhancement on single-detector helical CT at least 4 months after the last radiofrequency ablation. RESULTS: Complete necrosis was achieved in 101 (90%) of 112 hepatocellular carcinomas, with complete necrosis being achieved more frequently in hepatocellular carcinomas undergoing interactive ablation (96%) than standard ablation (85%) (p = 0.034). Power rolloff (a clinical end point in which power decreases as impedance increases) occurred in all of the 53 hepatocellular carcinomas that underwent interactive ablation, whereas power rolloff occurred in 48 (81%) of the 59 hepatocellular carcinomas that underwent standard ablation (p = 0.00053). Complete necrosis occurred more frequently when rolloff was achieved (96%) than without rolloff (36%) (p < 0.0001). Multivariate analysis determined that power rolloff was an independent factor in achieving complete necrosis of hepatocellular carcinomas (p < 0.0001). CONCLUSION: The use of interactive radiofrequency ablation increased the frequency of power rolloff and the rate of complete necrosis in the treatment of hepatocellular carcinoma. Power rolloff was a significant determinant of whether complete necrosis was achieved in hepatocellular carcinomas treated with radiofrequency ablation.     

超声引导下射频消融治疗子宫肌瘤临床价值研究

目的评估超声引导下射频消融治疗子宫肌瘤的临床疗效与安全性。方法对解放军85医院自2012年3月至2013年3月收治的148例子宫肌瘤患者进行超声引导下射频消融治疗。记录患者术前的主要症状。术前及术后3、6、12个月行阴式B超检查,观察肌瘤的位置,测量肌瘤3条径线长度,计算平均肌瘤体积及肌瘤缩小率。在术前及术后12个月采用子宫肌瘤症状及健康相关生活质量问卷(UFS-HRQL)评估子宫肌瘤相关症状及生活质量改善情况。观察术后12个月内术并发症发生情况。结果术前,术后3、6、12个月肌瘤平均体积分别为(23.33±22.80)cm~3、(12.47±11.83)cm~3、(6.88±6.52)cm~3及(4.45±4.26)cm~3;各术后组与术前组肌瘤平均体积比较,差异均有统计学意义(P<0.05)。术后3、6、12个月肌瘤缩小率分别为49.6%、70.3%、80.3%。117例有症状的患者中,术前、术后12个月平均UFS评分分别为(33.51±13.94)分、(5.77±4.50)分;平均QOL评分为分别为(68.09±15.17)分、(90.79±5.52)分;术前、术后UFS评分及QOL评分比较,差异均有统计学意义(P<0.05)。随访12个月,无严重并发症发生。结论 B超引导下射频消融子宫肌瘤对于无生育要求的、肌瘤较小(直径<6.5 cm)、随访条件好的患者,是一种临床价值较高的治疗手段,值得推广应用。     

Percutaneous radiofrequency treatment of osteoid osteoma using cool-tip electrodes

OBJECTIVES: To report our experience with percutaneous cool-tip radiofrequency ablation of osteoid osteomas and to evaluate clinical outcome. METHODS AND MATERIAL: Forty-one patients with clinically and radiologically suspected osteoid osteoma were seen over a 48-month period (27 males and 14 females with a mean age of 18.7 years; range 5-43 years). Thirty-eight patients were treated by computed tomography (CT)-guided percutaneous radiofrequency ablation. The procedure was performed under regional or general anaesthesia. After location of the nidus, a 14G-bone biopsy needle is introduced into the nidus. Sampling is performed with a 17G-bone biopsy needle using a coaxial technique. The radiofrequency needle with a 10mm active tip (cool-tip) is inserted through the biopsy needle and is connected to the radiofrequency generator for 6-8 min. RESULTS: Primary success was obtained in 37 patients (97%) with a 100% secondary success rate. All patients are currently pain-free. No major complications occurred. Patients could resume unrestricted normal activity within 24 h. CONCLUSIONS: Percutaneous radiofrequency ablation of osteoid osteomas is an efficient and safe method that can be considered the procedure of choice for most cases.     

Comparison of renal ablation with monopolar radiofrequency and hypertonic-saline-augmented bipolar radiofrequency: in vitro and in vivo experimental studies

OBJECTIVE: We sought to determine whether hypertonic-saline (HS)-augmented bipolar radiofrequency ablation has advantages over monopolar radiofrequency ablation for creating larger areas of coagulation necrosis in the kidney. MATERIALS AND METHODS: Using a 200-W generator and bipolar perfused-cooled electrodes or a monopolar cooled-tip electrode, we performed 14 radiofrequency ablations in explanted bovine kidneys. Radiofrequency was applied in standard monopolar (n = 7) or bipolar (n = 7) modes at 100 W for 10 min. In the bipolar mode, the perfused-cooled electrodes were placed at interelectrode distances of 3 cm, and a 6% sodium chloride solution was instilled into tissue at a rate of 2 mL/min through the electrodes. For in vivo experiments, either monopolar (n = 7) or HS-augmented bipolar (n = 7) radiofrequency ablation was performed in the lower pole of canine kidneys. Three days after the procedure, contrast-enhanced CT scans were obtained to evaluate the volumes of the ablation regions, and the kidneys were harvested for gross measurements. Technical parameters such as changes in impedance and current during radiofrequency ablation and dimensions of the thermal ablation zones were compared between the two groups. RESULTS: In ex vivo and in vivo experiments, the frequency of the pulsed radiofrequency application caused by rises in impedance was higher in the monopolar mode than in the bipolar mode during the application of radiofrequency energy. The in vivo study showed that the bipolar radiofrequency ablation allowed larger mean current flows than the monopolar radiofrequency ablation (i.e., mean +/- SD, 1,654 +/- 144 mA vs 967 +/- 597 mA) (p < 0.05). Ex vivo studies revealed that the volumes of bipolar radiofrequency-induced ablation regions were substantially larger than those of monopolar radiofrequency-induced ablation regions (26.1 +/- 10.5 cm(3) vs 10.2 +/- 4.2 cm(3)). In vivo studies showed bipolar radiofrequency ablation achieved larger coagulation necrosis than monopolar radiofrequency (3.2 +/- 0.3 cm vs 2.4 +/-0.4 cm) (p < 0.05). This was confirmed by the measured volume of nonenhancing area on contrast-enhanced CT (20.4 +/- 6.4 cm(3) vs 13.5 +/- 6.0 cm(3)). CONCLUSION: HS-augmented bipolar radiofrequency ablation using perfused-cooled electrodes shows better performance in creating coagulation necrosis than monopolar radiofrequency ablation in the kidney of an animal model.