射频消融治疗束支折返性室性心动过速一例

一例室性心动过速患者无扩型心肌病或缺血性心肌病基础,有明确的希-浦系统传导障碍,电生理检查可诱发两种室速:一种呈左束支传导阻滞型,心内激顺序为左束支-His束-心室;另一种呈右束支传导阻滞型,心内激动顺序为His束-左束支-心室。确诊为束支折返性室性心动过速,通过消融右束支治疗成功。     

房室折返性心动过速合并阵发性心房颤动的射频导管消融策略

目的探讨房室折返性心动过速（AVRT）合并阵发性心房颤动的射频导管消融（下称消融）策略。方法对经电生理检查证实的AVRT患者15例行旁道消融术,其中男性9例,女性6例,并对术后心房颤动的转归进行12～36个月的随访,观察心房颤动发生、持续时间、有无心律失常等情况。结果13例未再发生心房颤动,2例有严重器质性心脏病的患者仍有阵发性心房颤动复发,但发作次数明显减少,口服胺碘酮可控制症状。1例动态心电图示频发房性期前收缩。结论AVRT与阵发性心房颤动发生率增高密切相关,AVRT是心房颤动的触发因素。旁道消融后,阵发性心房颤动可明显改善,未改善者与心房扩大等心房基质未改善有关。     

老年人心动过速的导管射频消融治疗

射频消融治疗心动过速是一种有效的根治性方法。本文报告自1993年3月～1999年2月以来我院收治的47例老年人心动过速的射频消融(RFCA)治疗,重点讨论房室结折返性心动过速(AVNRT)与房室折返性心动过速(AVRT)消融体会。1　材料和方法1.1　临床资料在已完成RFCA的420例心动过速病人中,年龄≥60岁的老年人47例,男24例,女23例,平均年龄63±2(60～71)岁。冠心病2例,冠心病合并高血压4例,高血压合并糖尿病3例,心肌病1例,风心病1例,其余36例无其他心血管异常。4例伴有糖尿病,3例心动过速发作时伴有心绞痛,1例伴有左心衰。1.2　电生理标测和RF…     

束支折返性心动过速的诊治

束支折返性心动过速（BBRVT）是一种持续性单形性室性心动过速。近年来,随着诊疗技术的进步,大量临床病例的积累,BBRVT在诊治方面取得了一定的进展,但还存在很多的不足,所以至今仍未形成系统的诊治指南。本文就BBRVT的机制、分型、诊断和治疗等方面的进展作一综述。     

束支折返性心动过速的诊治

束支折返性心动过速(BBRVT)是一种持续性单形性室性心动过速。近年来,随着诊疗技术的进步,大量临床病例的积累,BBRVT在诊治方面取得了一定的进展,但还存在很多的不足,所以至今仍未形成系统的诊治指南。本文就BBRVT的机制、分型、诊断和治疗等方面的进展作一综述。     

常见心律失常的射频消融——房室结折返性心动过速的射频消融

房室结折返性心动过速 (AVNRT)是一种较为常见的室上性心动过速 ,为射频消融的经典适应证。射频导管消融术已被公认为根治 AVNRT的首选方法 ,成功率达 96 .1%～98.8%。1　 AVNRT的电生理特点目前 ,有关房室结的解剖结构、组织学形态以及 AVNRT的折返环路仍不十分清楚。一般认为 ,房室交界区存在解剖上或功能上的两条 (偶有多条 )径路 ,即 α径路 (慢径路 )和 β径路 (快径路 ) ,前者不应期短 ,传导速度慢 ;后者不应期较长 ,传导速度较快。组织学上发现快径路为前上组结周纤维 ,位于Koch三角的顶部 ,邻近房室结致密区 ;慢径路为后下…     

窦房折返性心动过速的电生理特点及射频消融

窦房折返性心动过速为一少见的室上性心动过速。现将 5例窦房折返性心动过速患者的电生理特点及射频消融结果报道如下。　　资料和方法　 5例窦房折返性心动过速患者 ,男性 3例 ,女性 2例。入院后停服抗心律失常药物≥ 5个半衰期 ,术前行食管心房起搏诱发心动过速。常规穿刺右颈内 ,左、右股静脉 ,置入冠状静脉窦、希氏束、右心室心尖部及高位右心房标测电极导线。进行高位右心房分级递增 (Ｓ1Ｓ1)及程序期前刺激 (Ｓ1Ｓ2 、Ｓ1Ｓ2 Ｓ3 、Ｓ1Ｓ2 Ｓ3 Ｓ4 )诱发心动过速 ,记录心内电图。送入 7ＦＷｅｂｓｔｅｒ大头导管至上腔静脉与右心房前…     

导管射频消融治疗房室结折返性心动过速的临床研究

房室结折返性心动过速 (atrioventricular nodal reen-trant tachycardia,AVNRT)是临床常见的心律失常 ,导管射频消融是近年来出现的根治 AVNRT的新疗法。我院从1992年至今以导管射频消融治疗 32 5例 AVNRT,经临床不断探索 ,近 4年成功率为 10 0 % ,无 1例并发三度房室阻滞 ,近 3年术后无 1例复发 ,现报道如下。　　资料和方法　从 1992年至今对 32 5例住院 AVNRT患者进行导管射频消融治疗。患者男性 132例 ,女性 193例 ,男女之比为 1∶ 1.49。年龄 12～ 6 8岁 ,平均 (4 5 .1± 12 .2 )岁。　　体格检查大多数未见异常。其中合并高…     

束支折返性室性心动过速射频消融后左心室功能的变化

目的 观察扩张性心肌病合并束支折返性室性心动过速(bundle branch reentry ventricular tachycardia,BBRVT)患者消融右束支后左心室功能的变化,探讨该消融方法治愈室速后对左心功能的长期影响.方法 自2007年12月至2010年2月,12例扩张性心肌病合并阵发性室速,电生理检查证实为BBRVT,标测右束支电位后予以消融,比较术前及术后12个月患者左室射血分数(left ventricular ejection fraction,LVEF);左室舒张末内径(left ventricular end distolic diameter,LVEDD);左室收缩末容量(left ventricular end systolic volume,LVESV);主动脉瓣口速度时间积分(velocity time integral,VTI);主动脉与肺动脉瓣开放时间差(QAO-QP);纽约心功能分级(NYHA);6分钟步行距离(6 minutes walk test,6-MWT);血浆脑钠肽前体(NT-proBNP)变化;心电图QRS宽度变化.结果 12例患者射频消融后随访1年均未再发作室速,与术前相比,术后12个月LVEF,VTI,NYHA,6-MWT均显著降低;LVEDD,LVESV,QAO-QP,NT-proBNP及QRS宽度均增加.结论 束支折返性室速消融右束支后可造成左右室间以及左室内收缩的不同步,可能是术后左室功能进一步减低的机制,但不能完全排除扩张性心肌病自身发展的影响.     

Radiofrequency catheter ablation for treatment of bundle branch reentrant ventricular tachycardia: results and long-term follow-up

Seven of 120 consecutive patients with inducible sustained ventricular tachycardia (from September 1, 1988 to January 1, 1991) had bundle branch reentrant tachycardia and underwent percutaneous radiofrequency ablation of the right bundle branch. The seven patients had been unsuccessfully treated with a mean of 3 +/- 1 drugs. Four patients presented with syncope and three with aborted sudden death. The baseline electrocardiogram revealed a left bundle branch block pattern in three patients and an intraventricular conduction defect in four. The baseline HV interval was prolonged in each case (79 +/- 2 ms). With use of programmed ventricular extrastimuli, sustained bundle branch reentrant tachycardia was inducible in all patients at a mean cycle length of 283 +/- 17 ms (range 230 to 350). Bundle branch reentrant tachycardia characteristics included atrioventricular dissociation, a His deflection that preceded each QRS complex and spontaneous His to His variation that preceded changes in ventricular tachycardia cycle length. A quadripolar catheter was positioned across the tricuspid valve with the distal electrode tip of the catheter near the right bundle branch. One to three applications of continuous unmodulated radiofrequency current at 300 kHz between the distal electrode and a large posterior skin patch resulted in complete right bundle branch block in all patients, after which none had inducible bundle branch reentrant tachycardia on restudy. On restudy, three of the seven patients had ventricular tachycardia of myocardial origin (not bundle branch reentry). One patient required no therapy; drug or defibrillator therapy was used in the others.(ABSTRACT TRUNCATED AT 250 WORDS)     

The radiofrequency catheter ablation of intranodal reentry tachycardia in children and adolescents]

INTRODUCTION: Radiofrequency catheter ablation of slow pathway is the primary nonpharmacological treatment for the atrioventricular node reentrant tachycardia at present. OBJECTIVES: To evaluate the results and long term follow-up of the catheter and radiofrequency modification of the AV node in the treatment of the atrioventricular node reentrant tachycardia in children and adolescents in our center. METHODS AND RESULTS: In a series of fifteen patients, 7 men and 8 women, with a mean age of 8.7 +/- 5.5 years (range, from 4 to 18) with atrioventricular node reentrant tachycardia underwent radiofrequency catheter ablation. Six patients had been treated previously with 1.4 +/- 1.1 antiarrhythmic drugs and nine had not received treatment. In all patients slow-pathway atrioventricular node ablation guided by an anatomic stepwise approach was attempted. In 14 out of 15 patients slow pathway was successfully ablated; and in one patient with a previously failed slow-pathway ablation, a fast-pathway ablation was performed. Tachycardia recurred in one patient, and slow pathway was ablated in a second procedure. After successful slow pathway ablation in 14 patients, the shortest cycle length in which the AV conduction was maintained at 1:1, was increased from 271.3 +/- 22.6 to 316.7 +/- 30.1 ms (p < 0.001), while the AH and HV intervals and shortest cycle length of 1:1 VA conduction remained unchanged. In the patient who had fast pathway ablation the AH interval was increased from 65 to 130 ms, and retrograde VA conduction was lost. Noninducibility of the tachycardia was achieved in all patients without significant complications. During a mean follow-up of 18.8 +/- 11.4 months (median of 16), all patients are symptom-free without medication. CONCLUSIONS: Radiofrequency catheter ablation is a successful and safe therapeutic alternative in the treatment of atrioventricular node reentrant tachycardia in children and adolescents.     

特发性室性心动过速的临床特点和射频消融治疗

目的对经射频消融术证实的特发性室性心动过速的病例进行总结分析,探讨室性心动过速的发病状况、心电图特点和消融结果.方法对127例特发性室性心动过速的发病年龄、性别、室性心动过速的起源部位和心电图进行分析,观察室性心动过速的诱发率,射频消融的成功率和复发率,分析消融术失败或室性心动过速复发的原因.结果经消融治疗的特发性室性心动过速好发于年轻人,左心室室性心动过速较右心室室性心动过速多见,11.8%的患者室性心动过速发作时可出现11室房逆传.右心室室性心动过速男女比例为1.01.3,额面QRS波平均心电轴为(+82.96±26.18),诱发率为90.2%,射频消融的成功率为85.4%.左心室室性心动过速男女比例为8.61.0,额面QRS波平均心电轴为(-88.15±43.73),诱发率为96.5%,射频消融成功率为93.0%.结论射频消融术是治疗特发性室性心动过速的一项成功率高、并发症少的相对成熟的技术,可以作为特发性室性心动过速的首选治疗手段.     

Transvenous catheter ablation of the His bundle in ventricular tachycardia

The usefulness of transvenous catheter ablation of the His bundle in three patients with recurrent ventricular tachycardia (VT), in which the initiating mechanism was recognized during a rapid atrial rhythm, is reported. Tachycardia was refractory to conventional treatment and required transthoracic direct-current shocks in all patients. In patient No. 1 double tachycardia (atrial flutter and VT) was documented and VT was easily induced by rapid atrial pacing. In patients Nos. 2 and 3 initiation of VT during junctional reciprocating and atrial tachycardia, respectively, was observed. Interruption of the His bundle was performed by means of fulguration. Stable atrioventricular (AV) block was observed in patient No. 1 after the ablative procedure; patient No. 2 showed anterograde conduction over a posterior septal accessory pathway with no evidence of conduction over the normal conduction system in both the anterograde and retrograde directions. In patient No. 3, transient AV block was observed; AV conduction resumed 2 days later and the cardiac rhythm showed persistent ectopic atrial tachycardia with second-degree AV block. Patients Nos. 1 and 2 underwent pacemaker implantation, but patient No. 2 was not pacemaker dependent. After the procedure, VT no longer occurred in any of the patients (follow-up: 2 years, 5 months, and 6 months).     

Radiofrequency catheter ablation of upper septal idiopathic left ventricular tachycardia exhibiting left bundle branch block morphology

Idiopathic left ventricular (LV) tachycardia usually exhibits right bundle branch block morphology. There are only a few sporadic cases that exhibit left bundle branch block (LBBB) morphology. We report a patient whose QRS complex during ventricular tachycardia (VT) was relatively narrow (100 msec) and exhibited LBBB (precordial R wave transition between V3 and V4) and a normal frontal plane axis. This VT was ablated successfully by radiofrequency current applied to the LV upper septum, where the earliest endocardial activation was recorded.     

Successful radiofrequency catheter ablation of "clockwise" and "counterclockwise" bundle branch re-entrant ventricular tachycardia in the absence of myocardial or valvar dysfunction without detecting bundle branch potentials

A case is reported of a patient with only isolated conduction abnormalities of the His-Purkinje system with no identifiable myocardial or valvar dysfunction, leading to "clockwise" and "counterclockwise" bundle branch re-entrant ventricular tachycardias (BBRVTs). The electrophysiological study showed infra-Hisian conduction system disease and two different inducible wide QRS complex tachycardias. Neither right bundle branch nor left bundle branch potentials were recorded despite extensive catheter manipulation. However, these tachycardias were diagnosed as BBRVTs by using entrainment manoeuvres and comparing the HV intervals during both sinus rhythm and the tachycardias. These tachycardias were eliminated by catheter ablation of the right bundle branch, using the morphology of the local electrograms and anatomical findings.