持续性交界区反复性心动过速的研究现状

持续性交界区反复性心动过速的研究现状河南省郑州市心血管病研究所刘怀霖金华综述北京医科大学人民医院郭继鸿审校持续性交界区反复性心动过速（ｐｅｒｍａｎｅｎｔｊｕｎｃｔｉｏｎａｌｒｅｃｉｐｒｏｃａｔｉｎｇｔａｃｈｙｃａｒｄｉａ，ＰＪＲＴ）是临床少见的心律失...     

导管射频消融术治疗持续性交界区反复性心动过速2例报告

本文报告两例持续性交界区反复性心动过速(PJRT)患者,应用导管射频消融术治疗,成功地阻断了位于后间隔具有递减传导特性的稳若旁路.随访7～10个月.病人无心动过速发作,提示导管射频消融术是治疗PJRT的有效方法.     

房性心动过速与持续性交界区反复性心动过速的快速鉴别

目的 初步探讨房性心动过速（房速）与持续性交界区反复性心动过速（ｐｅｒｍａｎｅｎｔ ｊｕｎｃｔｉｏｎａｌ ｒｅｅｉｐｒｏｃａｔｉｎｊｇ ｔａｃｈｙｃａｒｉｄａ,ＰＪＲＴ）快速鉴别方法。方法 ３６例室上性心动过速患者,经心内电生理检查,其中３０例诊断为房速,６例诊断为ＰＪＲＴ;心动过速时于右心地Ｓ１Ｓ１起搏（Ｓ１Ｓ１间期较心动过速周长短１０～４０ｍｓ）,观察心卢搏呈１：１室房（ＶＡ）传导者停止起搏后     

持续性交界区反复性心动过速的近年研究进展

持续性交界区反复性心动过速 (Ｐｅｒｍａｎｅｎｔｊｕｎｃ ｔｉｏｎａｌｒｅｃｉｐｒｏｃａｔｉｎｇｔａｃｈｙｃａｒｄｉａ,ＰＪＲＴ)是一种临床少见而药物治疗效果不佳的心律失常。 1967年 ,法国学者Ｃｏｕｍｅｌ率先报告了ＰＪＲＴ ,提出其临床特点和电生理的特征。 1978年Ｇａｌｌａｇｈｅｒ对ＰＪＲＴ作了进一步较为全面的阐述。 1984年意大利学者Ｃｒｉｔｅｌｌｉ指出ＰＪＲＴ好发于房室交界区 ,该旁道具有慢旁道特性[1] 。随着心脏电生理研究的不断深入 ,人们对ＰＪＲＴ的认识也更加清楚 ,现已证实ＰＪＲＴ实质为慢旁路参与的顺向型…     

持续性交界区反复性心动过速的电生理特征及射频消融

报告６例持续性交界区反复性心动过速的电生理特征及射频消融结果。平均病史２２年，平均心动过速周长３８８ｍｓ，１例ＲＰ＞ＰＲ，５例ＲＰ＜ＰＲ。心动过速均为房室结前传，具有递减传导的旁路逆传。３例旁路在右后间隔，１例旁路在左游离壁，１例旁路在左后间隔，１例旁路位于右游离壁。射频消融均成功阻断旁路，无任何并发症，平均随访６个月，未用任何药物无一例再发心动过速。本文分析了持续性交界区反复性心动过速的电生理特征，并提出了诊断标准。     

射频消融治疗心动过速性心肌病

心动过速性心肌病是由于长期心动过速引发心脏扩大和心功能不全 ,类似扩张型心肌病 ,其特点是一旦心动过速得以控制 ,原来扩大的心脏和心功能不全可部分或完全恢复正常。现将 10例心动过速性心肌病导管射频消融 (ＲＦＣＡ)治疗前及术后 6～ 12个月时临床对比研究结果分析如下。1993年 1月至 1997年 12月 ,10例患者 ,男 8例、女 3例 ,年龄 5 2± 12 .5 (4 8～ 6 4)岁 ;本组患者阵发性心慌、胸闷、气短5～ 12年 ,入院时均有不同程度的气喘、夜眠时不能平卧 ,伴双下肢浮肿 ,经心电图或 /和动态心电图证实 6例预激伴心房颤动。 4例持续性交界性…     

射频消融治疗折返性房性心动过速

射频消融治疗折返性房性心动过速吴书林，郑祥生，欧阳非凡，钱卫民，李海杰，孙家珍，尹滔业，冯建章作者单位：广东省人民医院，广东省心血管病研究所（５１００８０）本文报告射频消融成功治疗折返性房性心动过速一例，并对有关电生理结果和定位标测略加讨论。临床资料...     

射频能量测试交界性心律消融房室结折返性心动过速

探讨能量测试法在房室结折返性心动过速 (AVNRT)慢径标测与消融中的作用。将 90例AVNRT患者分成三组 (每组 30例 ) ,分别采用能量测试法、下位法和后位法进行慢径标测与射频消融。能量测试法是在Koch三角区逐步以小剂量多次试验放电标测 ,以出现加速性交界性心律为慢径传导部位 ;从 2 0W开始消融并增至 30W ,持续 12 0s ,以出现加速性交界性心律且逐渐转变为窦性心律为消融有效。能量测试法所需手术标测时间、X线曝光时间和消融能量明显少于后位法 (12 1± 43vs 183± 6 7min ,5 8± 2 1vs 93± 34min ,70 0 0± 470vs 12 0 0 0± 75 0J,P≤ 0 .0 5 ) ,而发生短暂性房室阻滞和交界性心动过速则均较下位法明显减少。慢径消融有效时几乎 10 0 %出现加速性交界性心律 ;慢径传导呈多部位分布。结论 :能量测试法运用于AVNRT慢径标测及消融中 ,能较敏感地揭示慢径传导部位和消融有效的靶点 ,为AVNRT慢径标测消融的有效方法。     

心肌梗死后室性心动过速的射频消融治疗问题

心肌梗死(MI)后室性心动过速(VT)是导致患者心室颤动及猝死的主要原因之一。近年来,射频消融(RF)用于MI后VT治疗收到了较好的效果。但是,由于标测和消融技术的限制,该项技术仅能用于血流动力学稳定的单形性持续性室性心动过速、药物治疗无效和(或)安装了植入型心律转复除颤器(ICD)频繁放电的患者。本文就MI后VT的射频治疗存在的问题予以综述。     

射频导管消融治疗15个月患儿持续性左心房房性心动过速一例

报道射频导管消融1例15个月患儿持续性左心房房性心动过速（AT）。     

Permanent form of junctional reciprocating tachycardia in adults: peculiar features and results of radiofrequency catheter ablation.

AIM: PJRT occurs predominantly in infants and children and is limited to small series in adults. The aim of this study was to describe the clinical presentation, electrophysiological characteristics, feasibility and safety of radiofrequency ablation, and the long-term prognosis in a large group of adult patients with the permanent form of junctional reciprocating tachycardia (PJRT). METHODS AND RESULTS: Forty-nine adult patients (22 male and 27 female; mean age 43+/-16) with a diagnosis of PJRT confirmed at electrophysiological study were included. Eight patients (16%) presented with tachycardia-induced cardiomyopathy (TIC). Ventricular rate was 146+/-30 bpm. The arrhythmia was permanent or incessant in 23/49 cases (47%) and paroxysmal in 26/49 (53%). A significant correlation was found between symptom duration and tachycardia rate (r(2)=0.12, P=0.01). The accessory pathway (AP) was located in the right posteroseptal region in 37 cases (76%) and in atypical sites in 12 cases (24%).Patients with the incessant or permanent form of PJRT had longer duration of symptoms, more frequently TIC and a slower tachycardia rate. Radiofrequency catheter ablation was initially successful in 46 cases (94%) without any serious complication. Long-term success rate was 100% (49/49 patients) in the absence of any antiarrhythmic drug treatment (mean follow-up 49+/-38 months). Regression of TIC was observed in all cases (8/8). CONCLUSION: PJRT in adults is often paroxysmal (53%), and the retrograde slowly conducting, decremental AP is not infrequently in a non-posteroseptal location. Radiofrequency catheter ablation is highly effective and should be considered as the treatment of first choice in adult patients with PJRT.     

Transient QT prolongation with torsades de pointes tachycardia after ablation of permanent junctional reciprocating tachycardia

INTRODUCTION: Catheter ablation with radiofrequency energy is a curative therapy in patients with permanent junctional reciprocating tachycardia (PJRT). METHODS AND RESULTS: For the first time, we report a case of transient QT prolongation with torsades de pointes tachycardia 18 hours after successful radiofrequency energy ablation of PJRT in a 25-year-old woman with tachycardia-induced cardiomyopathy. Of note, the torsades de pointes occurred in the absence of bradycardia, electrolyte disturbances, or QT-prolonging drugs. This patient initially was thought to have a hereditary long QT syndrome that was unmasked by PJRT ablation. Therefore, the patient received an implantable defibrillator in addition to beta-blocker therapy, which was discontinued 6 months later. Surprisingly, the QT interval completely normalized within 1 week after PJRT ablation, and the patient remained free of arrhythmias during a follow-up period of 4.5 years. CONCLUSION: Patients with incessant tachyarrhythmias should undergo ECG monitoring for at least 24 hours following successful radiofrequency catheter ablation because transient QT prolongation with torsades de pointes may occur even in the absence of bradycardia, QT-prolonging drugs, or electrolyte disturbances.     

Cryoenergy catheter ablation: a new technique for treatment of permanent junctional reciprocating tachycardia in children

INTRODUCTION: Permanent junctional reciprocating tachycardia (PJRT) is an infrequent form of reciprocating tachycardia, almost incessant from childhood and usually refractory to drug therapy. Radiofrequency catheter ablation currently is the first-line therapy for PJRT, but its application in the septal region may be associated with complications. In contrast, cryoenergy has several advantages, such as the ability to test the effects of ablation while the lesion is still forming, thus reducing the number of ineffective, useless, and potentially harmful lesions. The aim of this study was to investigate the potential clinical utility of percutaneous cryoenergy catheter ablation for treatment of pediatric patients with PJRT. METHODS AND RESULTS: Four patients (age 14 +/- 5 years; mean +/- SD) with a clinical diagnosis of PJRT underwent catheter cryoablation. The ablation was successfully accomplished in 4 (100%) of 4 patients. The mean +/- SD number of cryoapplications was 1.8 +/- 0.8, and from 1 to 6 cryomappings were performed for each permanent cryolesion. The successful site was in the mid-septal region (2 patients), at the coronary sinus orifice (1 patient), and in the middle cardiac vein (1 patient). No complications with cryoablation were reported, nor was there prolongation of the AH interval during cryomapping or cryoablation. No pain was reported by patients during the cryoenergy catheter ablation procedure. PJRT recurrence occurred in 1 patient who underwent a second successful cryoablation procedure. CONCLUSION: The outcomes of cryoenergy catheter ablation in these 4 patients treated for PJRT suggest that cryoablation is a safe, effective, and pain-free technique for treating pediatric patients with PJRT.     

Outcomes of radiofrequency catheter ablation of atrioventricular reciprocating tachycardia in patients with congenital heart disease

OBJECTIVES: Assessment of clinical outcomes of catheter ablation of atrioventricular reciprocating tachycardias in patients with congenital heart disease (CHD). BACKGROUND: Atrioventricular reciprocating tachycardias occur in patients with CHD and may be poorly tolerated. METHODS: Retrospective review of all 105 such ablations in 83 patients performed between 03/90 and 02/02 at one institution. RESULTS: The dominant arrhythmia mechanism was accessory pathway (70 patients, 84%), and the most common indications were drug-refractory tachycardia, life-threatening arrhythmia, and elective presurgical ablation. Congenital heart disease diagnoses were diverse, with one third of patients having Ebstein's anomaly. Twenty patients (24%) had catheter access limited by prior surgeries or occluded vascular access. Of 109 accessory pathways (APs), 74 (68%) were manifestly preexcited, and 71 (65%) were located on the right atrioventricular groove. Fourteen patients (20%) had multiple pathways. There were 2 major complications (1 death, 1 hemorrhage), and 3 minor complications (5.5% of procedures). Acute success rate was 80% per procedure, 82% for left- and 70% for right-sided APs. Acute success rates for patients with Ebstein's anomaly were similar to patients with other CHD diagnoses, but Ebstein's patients were more likely to have recurrence. At 44 +/- 35 months follow-up, successful ablation was achieved in 59% of procedures and 68% of patients, with 19 patients (23%) undergoing one or more repeat ablations. CONCLUSIONS: Compared to patients with normal cardiac anatomy, patients with CHD of all varieties have lower rates of acute and long-term success for ablation for atrioventricular reciprocating tachycardias.     

经导管射频消融治疗室性心动过速的疗效观察

室性心动过速是临床上较常见的心律失常,可发生于健康人群和各种心脏病患者。由于其可造成严重的症状甚至危及生命,因而需要积极处理,目前导管射频消融已逐渐成为首选治疗。我院近2年经导管射频消融治疗室性心律失常患者11例,现报道如下,以评价其临床疗效及安全性。     

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.     

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     

Lasso电极导管指导下标测与射频消融局灶性房性心动过速

目的 探讨10极Lasso电极导管对局灶性房性心动过速(房速)标测及射频消融的指导作用.方法 局灶性房速病人5例,接受电生理检查,初步判断房速起源于左心房或右心房;应用Lasso电极标测心房,指导消融导管寻找局灶性房速最早心房激动(A波)点,于最早心房激动点处消融.结果 局灶性房速病人5例均在房速持续发作时进行Lasso电极标测;消融导管在Lasso电极指导下分别于左心房耳部(2例)、左上肺静脉口部(1例)、上腔静脉(1例)、右心房侧壁(1例)标测到最早A波;较P波提早30～40 ms;Lasso电极记录的A波顺序均呈离心性;在上述最早激动点处消融,均成功终止房速,放电次数为1～3次;未出现并发症;随访2～20个月,无复发;手术时间40～60 min,X线照射时间8～12 min.结论 应用Lasso电极指导标测与射频消融局灶性房速,快速、准确,可提高消融成功率,减少X线照射时间,缩短手术时间,特别对病灶位于心内大静脉、心房耳部病例尤有帮助.