快速心律失常的治疗

快速心律失常的药物治疗、电学治疗、经导管射频电消融(RFCA)治疗及起搏器治疗近年来均有飞跃发展,本文谈谈个人体会。1　阵发性室上性心动过速(PSVT)PSVT包括预激综合征房室折返性心动过速(AVRT)、房室结折返性心动过速(AVNRT)、房性心动过速、心房扑动与心房颤动等。过去教科书中认为AVNRT发病率超过AVRT,据我们近1000例RFCA的统计,AVRT占60%,居首位,其中隐匿性预激综合征引起PSVT更多见。AVNRT占32%,居PSVT的第2位。PSVT药物治疗以维拉帕米和普罗帕酮为首选。过去曾提倡快速静脉注射ATP终止PSVT,因其剂量不好控…     

射频消融治疗阵发性室上性心动过速110例

目的分析射频消融(RFCA)治疗阵发性室上性心动过速(PSVT)的疗效。方法回顾性分析110例患者临床资料,均采用常规RFCA治疗PSVT患者。结果房室折返性心动过速(AVRT)65例,预激综合征合并房颤3例,计有旁道70条,显性旁道35条,隐匿性旁道35条,其中位于冠状静脉窦憩室颈部心外膜旁道1例,双旁路2例均为左侧。房室结折返性心动过速(AVNRT)42例,均为慢-快型,其中有两例患者术中未能诱发出心动过速,予RFCA阻断慢径治疗。RFCA治疗PSVT总成功率为99.1%,其中房室结双经路介导的PSVT成功率高达100%,复发率为3.6%,均复治成功,并发症发生率5.6%。结论采用常规方法RFCA治疗PSVT成功率高,并发症少。     

常规三维与零射线射频消融治疗阵发性室上性心动过速的对比研究

目的 比较常规三维组与零射线组导管射频消融(RFCA)治疗阵发性室上性心动过速(PSVT)的安全性、有效性.方法 选2018年12月-2019年6月阜阳市人民医院因PSVT行RFCA的62例患者,根据手术有无使用X线分为零射线组(31例)和常规组(31例),比较两组总手术时间、电极到位时间、曝光时间、消融时间、即刻成功率、成功率、复发率、手术并发症.结果 零射线组即刻成功率96.77%,1例慢径改良,术后无复发.常规组即刻成功率100%,术后无复发.零射线组电极到位时间多于常规三维组,但曝光时间为零,差异有统计学意义(P<0.05).总手术时间、消融时间、即刻成功率、成功率、手术并发症差异无统计学意义(P>0.05).结论 零射线射频消融治疗PSVT安全有效,无X线伤害.     

射频消融术治疗阵发性室上速330例报告

射频消融术 (RFCA)是目前治疗阵发性室上性心动过速(PSVT)最有效的方法。自 1993年 2月至今 ,我们对 330例PSVT患者实施 RFCA,成功率为 92 .9% ,现报告如下。资料与方法 :本文 330例中 ,男 2 12例、女 118例 ,年龄 8～ 72岁、平均 46 .6岁。房室折返性心动过速 (AVRT) 2 2 8例 ,房室结折返性心动过速 (AVNRT) 84例 ,房性心动过速 (AT)18例。将其分为两组 ,1998年 1月 1日以前为 A组 12 7例 ,以后为 B组 2 0 3例 ,两组性别、年龄、病情比较具有可比性。RFCA方法 :1电生理检查 :经静脉送入 2～ 3根电极导管 ,分别置于高位右心房…     

三维标测系统指导房室折返性心动过速射频消融的临床特征分析

<正>射频消融术(RFCA)治疗房室折返性心动过速(AVRT)手术成功率高,并发症发生概率小,相对于药物治疗可以达到根治目的,已经成为AVRT治疗的首选方案~([1-3])。本研究通过比较三维标测系统和X线透视下不同类型AVRT的RFCA在手术操作时间、X线曝光时间、即刻成功率、并发症发生率、术后心动过速复发率等的差异,分析三维标测RFCA应用的临床特征及有效性和优势性。     

基层医院开展射频消融治疗室上性心动过速的体会(附52例临床报告)

目的:总结基层医院开展射频消融(RFCA)治疗阵发性室上性心动过速(PSVT)的经验和教训.方法:对52例PSVT进行射频消融,其中房室结折返性心动过速(AVNRT)24例,房室折返型心动过速(AVRT)28例,均先行心内电生理检查,寻找最佳靶点进行消融.结果:消融总成功率98%,无1例严重并发症,随访1～20个月无1例复发.结论:基层医院开展射频消融治疗PSVT时充分的人才、技术及设备是提高成功率的关键.     

Swartz鞘在阵发性室上性心动过速常规射频消融失败病例中使用方法探讨

目的 对47例阵发性室上性心动过速(PSVT)用常规电生理标测和导管射频消融(RFCA)未成功者改用Swartz鞘作为支撑，探讨Swartz鞘在提高PSVT消融成功率中作用。方法右房房性心动过速(AT)和房室结折返性心动过速(AVNRT)慢径路消融用SRoSwartz鞘，左侧房室旁路(AP)并房室折返性心动过速(AVRT)穿房阿隔后用SL，鞘，右侧AP据不同部位用SR4、SR2、SR3鞘。结果47例PSVT常规方法消融未成功者其中46例改用Swartz鞘作支撑后获得成功。结论 Swartz鞘的使用明显提高PSVT患者RFCA的成功率。     

室上性心动过速射频消融前后QTc,JTc离散度的观察

文献报道 ,阵发性室上性心动过速 (PSVT)接受射频电流消融 (RFCA) ,不论使用多大能量 ,术后心肌酶变化的峰值均有不同程度升高 ,提示 RFCA对心肌组织有一定损伤。但此种损伤是否会引起心脏电生理的异常改变 ,研究较少。分析我院 1 0 9例PSVT患者射频消融治疗前后 QTc及 JTc离散度(QTcd及 JTcd)变化 ,旨在探讨 RFCA是否影响心室肌复极的时间及引起心室肌复极的不同步和电不稳定。资料与方法对象　经 RFCA治疗 PSVT的显性预激综合征、隐匿性旁路及房室结双径路且术前及术后心电图资料完整的 1 0 9例患者 ,剔除了电解质和酸碱平…     

射频消融隐匿慢性旁道前传性心动过速一例报告

<正> 采用射频消融(RFCA)有逆传动功能的隐匿旁道(CBT)治疗房室折返心动过速(AVRT),是近年来应用于临床的新技术,术中CBT标测是RFCA成 功的关键.对少见隐匿型慢传导旁道(CBTs)参与者,标测准确性尤为重要.本文报道成功消融CBTs参与的AVRT一例.     

1018例房室和房室结折返性心动过速患者的年龄和性别分析

1018例行射频消融治疗的阵发性室上性心动过速(PSVT)中房室结折返性心动过速(AVNRT)女性多于男性,房室折返性心动过速(AVRT)女性少于男性。中年是所有PSVT患者行射频消融术的高峰年龄。随着年龄的增长,AVRT患者所占的比例逐渐下降。结论:行射频消融术的PSVT患者有年龄和性别特征。     

异丙肾上腺素与阿托品诱发阵发性室上性心动过速的对比观察

目的 对比观察异丙肾上腺素与阿托品试验在经食管心房调搏中诱发室上性心动过速的异同。方法 87例阵发性室上性心动过速病人,54例用异丙肾上腺素(Iso组,2μg/min静脉滴注),33例用阿托品(Atr组,0.04mg/kg静脉注射)后重复经食管心房调搏检查。结果 异丙肾上腺素与阿托品诱发成功率分别为83.3%、66.7%,前者略高于后者,但两者无显著差异(P>0.05);异丙肾上腺素诱发房室结折返性心动过速多于房室折返性心动过速,而阿托品诱发房室折返性心动过速多于房室结折返性心动过速,两者有显著差异(P<0.05)。结论 异丙肾上腺素、阿托品均可取得大致相同的阵发性室上性心动过速的诱发成功率,仅在诱发室上性心动过速的类型上有一定差异。     

射频消融治疗快速心律失常244例临床分析

目的总结射频消融治疗快速心律失常的经验。方法回顾性分析244例经导管射频消融治疗快速心律失常患者的治疗结果。其中男性112例,女性132例,年龄12～83(46±16)岁。心动过速发作史1d至48年,平均(10±8)年。采用常规方法行电生理检查及射频消融。结果房室结折返性心动过速114例,房室折返性心动过速117例,房室结折返合并房室折返性心动过速4例,房速5例,房扑3例,房室结折返性心动过速合并房速1例。射频消融总成功率96.7%,复发率4.1%。术后I度房室传导阻滞2例,Ⅲ度传导阻滞1例,气胸3例。结论射频消融成功率高,并发症少,是治疗快速心律失常安全有效的方法。     

Influence of age and gender on the mechanism of supraventricular tachycardia.

OBJECTIVES: The objective of this study was to determine the impact of age and gender on the mechanism of paroxysmal supraventricular tachycardia (PSVT). BACKGROUND: Previous studies have indicated that PSVT mechanism may be influenced by age and gender, but contemporary data are limited. METHODS: In 1,754 patients undergoing catheter ablation of 1,856 PSVTs between 1991 and 2003, the mechanism was classified as atrioventricular reentrant tachycardia (AVRT), atrioventricular nodal reentrant tachycardia (AVNRT), or atrial tachycardia (AT). Patients with inappropriate sinus tachycardia, atrial flutter, atrial fibrillation, and age <5 years were excluded. RESULTS: The mean age was 45 +/- 19 years (range 5-96), and the majority were women (62%). Overall, AVNRT was the predominant mechanism (n = 1,042 [56%]), followed by AVRT (n = 500 [27%]) and AT (n = 315 [17%]). There was a strong relationship between age and PSVT mechanism; the proportion of AVRT in both sexes decreased with age, whereas AVNRT and AT increased (PM < .001 by ANOVA). The majority of patients with AVRT were men (273/500 [54.6%]), whereas the majority of patients with AVNRT and AT were women (727/1,042 [70%] and 195/315 [62%], respectively). The distribution of PSVT mechanism was significantly influenced by gender (P < .001). In women, 63% had AVNRT, 20% had AVRT, and 17.0% had AT. In men, 45% had AVNRT, 39% had AVRT, and 17% had AT. AVNRT replaced AVRT as the dominant PSVT mechanism at age 40 in men and at age 10 in women. CONCLUSIONS: The mechanism of PSVT in patients presenting for ablation is significantly influenced by both age and gender.     

Radiofrequency ablation for treating paroxysmal supraventricular tachycardia complicated by atrial fibrillation:A single-center retrospective analysis

Background The effect of selective radiofrequency ablation for treating paroxysmal supraventricular tachycardia(PSVT) and its associated paroxysmal atrial fibrillation(PAF) was assessed. Methods Data were collected retrospectively from patients diagnosed of PSVT and subsequently treated with radiofrequency ablation. Regular monthly follow-up by dynamic electrocardiography(ECG) was performed. Incident rates of atrial fibrillation before and after ablation were compared. Results 382 PSVT patients with 58 having atrial fibrillation were enrolled. The order of complicated PAF from high to low in these patients was displayed as: atrial tachycardia(AT),atrioventricular reentrant tachycardia(AVRT) and atrioventricular nodal reentrant tachycardia(AVNRT). Among AVRT patients, PAF was more frequent in patients having accessory pathways. AVNRT patients had significantly lower PAF rate comparing to other patients. PAF incident rate was significantly reduced by radiofrequency ablation therapy. Conclusion We advise regular dynamic ECG for PSVT patients, especially those with atrial flutter, AT or pre-excitation syndrome. Selective radiofrequency ablation is a feasible approach for treating AF complicated PSVT patients.     

儿童和青少年快速性心律失常的临床特点

研究儿童和青少年快速性心律失常的临床特点。选择 1995～ 2 0 0 2年在我院行射频消融 (RFCA)治疗的儿童和青少年快速性心律失常患者 ,共 32 1例 ,男 2 10例、女 111例 ,年龄中位数 13.4± 3.6 (1.5～ 18)岁 ;其中 ,房室折返性心动过速 (AVRT) 2 0 4例、房室结折返性心动过速 (AVNRT) 74例、特发性室性心动过速 (IVT) 35例、房性心动过速 (AT) 5例、心房扑动 (AFL) 2例、不适当窦性心动过速 (IST) 1例。记录所有病例术前未发作心动过速及心动过速发作时的体表 12导联心电图 ,结合电生理检查 ,分析其临床特点。结果 :AVRT、AVNRT和IVT分别占6 3.6 %、2 3.1%和 10 .9%。年岁较小的儿童和青少年 ,右侧旁道较多 ,随着年龄的增加 ,左侧旁道相对越来越多。B型预激合并多旁道较常见。 35例IVT ,其中 2 3例为左室IVT ;6例为右室IVT。 12例合并先天性心脏病 ;13例并发心动过速性心肌病 ,心功能及心脏大小在RFCA术后 3～ 6个月恢复正常。结论 :①AVRT、AVNRT和IVT是儿童和青少年快速性心律失常中最常见的 3种类型。②心动过速性心肌病经早期适当的治疗是可逆的。     

腺苷终止房室结和房室旁道折返性心动过速的心内电生理评价

探讨腺苷对阵发性室上性心动过速 (PSVT)的终止效果 ,观察PSVT终止后出现的心律失常。 2 5例患者 ,其中房室结折返性心动过速 (AVNRT) 11例、房室折返性心动过速 (AVRT) 14例 ,于心内电生理检查时 ,由前臂静脉注射(简称静注 )腺苷 6～ 12mg ,观察其终止心动过速的疗效和作用部位。结果 :11例AVNRT患者静注腺苷后 ,10例恢复窦性心律 ,其中 9例终止AVNRT于慢径前传 ,1例于快径逆传 ;14例AVRT患者静注腺苷后 ,14例均恢复窦性心律 ,终止AVRT 12例于房室结前传 ,2例于旁道逆传。心动过速终止后最常出现的心律失常是房性早搏和一过性Ⅰ和Ⅱ度房室阻滞 ;此外 ,室性早搏也很常见 ,部分患者可出现短阵室性心动过速 ,1例患者出现预激综合征伴心房颤动。结论 :腺苷终止PSVT有较高的成功率 ,但有潜在的促心律失常作用。     

aVR导联ST段抬高对阵发性室上性心动过速的鉴别价值

目的探讨aVR导联ST段抬高及其持续时间对阵发性室上性心动过速(PSVT)的鉴别价值。方法126例行射频消融治疗成功的PSVT患者,其中房室折返性心动过速(AVRT)65例,房室结折返性心动过速(AVNRT)61例。分析其aVR导联ST段抬高幅度及持续时间。结果65例AVRT中aVR导联ST抬高且持续时间≥0.08s有46例,61例AVNRT中有13例,诊断AVRT的敏感性、特异性及阳性预测值分别为70.8%,78.7%,78.0%;46例aVR导联ST段抬高的AVRT中左侧旁道占38例,诊断左侧旁道的敏感性、特异性及阳性预测值分别为79.2%,52.9%,82.6%。结论aVR导联ST段抬高及其持续时间有助于鉴别阵发性室上性心动过速,且其多发生于左侧旁道。     

食管电生理诊断阵发性室上性心动过速

目的探讨食管电生理诊断阵发性室上性心动过速(paroxysmal supraventricular tachycardia,PSVT)及分型的准确性。方法收集经食管电生理和心内电生理检查并行射频消融治疗的PSVT42例,将两种电生理对PSVT的诊断及分型进行比较,用X2检验,以P<0.05为差异有统计学意义。结果两种电生理检查诊断房室结双径路、慢快型房室结折返性心动过速、常见的顺向型房室折返性心动过速差异无显著性,食管电生理对房室旁路的粗略定位准确性较高,但对快慢型房室结折返性心动过速、慢房室旁路参予的房室折返性心动过速与房性心动过速不易辨别。结论食管电生理诊断常见类型的PSVT与心内电生理有相似的价值,且具有无创、简便、费用低等优点;但对不常见或复杂的PSVT不易辨别。     

三维电场导航系统非透视引导下导管消融治疗阵发性室上性心动过速

目的探讨三维电场导航系统(EnSite-NavX)非X线透视引导下导管射频消融术(RFCA)治疗阵发性室上性心动过速(PSVT)的可行性。方法对42例PSVT患者,在NavX系统非X线透视引导下行RFCA。结果 42例PSVT,其中房室结折返性心动过速22例、房室折返性心动过速20例(右侧旁道4例,左侧旁道15例,左、右侧双旁道1例),全部消融成功,无严重并发症发生。前8例为验证消融靶点位置行数秒X线透视,1例患者左锁骨下-奇静脉迂曲畸形,行静脉造影,1例左前隐匿性旁道非X线透视引导下消融未成功,改在透视下消融,更换合适消融导管消融成功,X线曝光时间6 m in,其余患者手术全程在非X线透视下完成。结论 NavX非透视引导下行RFCA是可行的。     

Retrospective analysis of 300 cases of paroxysmal supraventicular tachycardia by electrophysiological transesophageal study

AIM: Paroxysmal supraventricular tachycardia (PSVT) is a very frequent type of arrhythmia. Atrioventricular nodal reciprocating tachycardia (AVNRT) and atrioventricular reciprocating tachycardia through extranodal accessory pathways (AVRT) are the most common types of paroxysmal supraventricular tachycardia. We describe our experience in diagnosing these tachycardia by electrophysiological transesophageal study (ETS). METHODS: Three hundred patients, 155 men and 145 women, (mean age, 37.2 +/- 16 years), with a history of palpitations underwent clinical evaluation and ETS. The clinical features of those with AVNRT and those with AVRT were compared. RESULTS: Of a total of 300 patients, tachycardia was diagnosed only in 234, of which 136 (58%) had AVNRT and 98 (42%) had AVRT. AVNRT patients were older than those with AVRT (P = or < 0.004); patients with AVRT had palpitations earlier (P = or < 0.0001). Dyspnea and asthenia were the most frequent symptoms in the AVNRT patients (P = or < 0,02; P = or < 0.04). There were statistically significant differences between the two patient groups in Wencke-bach time (P = or < 0.05), ventricular-atrial (V-A) interval (P = or < 0.03) and period of induced tachycardia (P = or < 0.04). CONCLUSIONS: ETS revealed important clinical and electrophysiological differences between patients with AVRT and those with AVNRT.