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房室结双径路(DAVNP)是房室结折返性心动过速(AVN-RT)的电生理基础.其本质是解剖性的或功能性的,迄今尚未完全阐明.射频消融(RFCA)是治疗AVNRT的有效方法.房室结改良应首选慢径消融.本文试图通过23例次RCA治疗AVNRT时出现交界区心律几率的观察,说明交界区心动过速(JT)的出现至消失,可作为预测RFCA阻断慢径的指标. 相似文献
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目的探讨房室结慢径路消融有效放电过程中,心电监测的临床意义。方法分析55例慢-快型房室结折返性心动过速(S-F AVNRT),在有效靶点以低能量(15~25W)放电时的心电监测资料。结果55例房室结慢径路消融均获成功,有效放电过程均出现交接区心搏。7倒出现一过性房室传导阻滞(AVB),其中5例于交接区心搏伴室一房阻滞即刻停止放电后发生,2例于窦性心搏P—R间期延长即刻停止放电后发生,无1例出现持续性AVB。随访3~48个月,4例复发,均再次消融后未再复发。结论心电监测可指导射频能量的应用,避免持续性AVB的发生。 相似文献
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导管射频消融(RFCA)治疗房室结双径路折返性心动过速已比较成熟,广眨应用于临床,其并发症虽少但应受到重视。现将我院心包填塞并发症一倒报告如下: 相似文献
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射频消融治疗儿童房室结折返性心动过速 总被引:1,自引:0,他引:1
目的:为评价射频导管消融在治疗儿童房室结折返性心动过速的临床价值,本文回顾分析37例儿童射频消融结果评价、安全性及疗效。方法:选择6 ̄15见多识广心室结折返引起频发的、药物治疗无效的心动过速患儿,常规电生理检查,采用下位法消融慢径路。结果:37例中房室结双径路32例、三径路5例,全部消融成功,并发I度AVB1例,消融电极压迫出现一过性Ⅲ度AVB3例,复发率13.5%,随访中无房室传导阻滞及X线放射 相似文献
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目的比较房室结双径路伴房室结内折返性心动过速(AVNRT)患者,射频消融(RFCA)慢径路改良术,消融前、后心脏各部分腔内电生理改变。方法在相同条件下,于消融前、后分别进行腔内电生理检查。记录消融前、后:希氏束电图(HIS),心房有效不应期(A—ERP),功能不应期(A—FRP),心室有效不应期(V—ERP),功能不应期(V—FRP),房室结前传有效不应期(AVN—ERP),前传文氏点(AVN—WKB),房室结逆传有效不应期(VAN—ERP),逆传文氏点(VAN—WKB),将消融前、后心脏各部分电生理参数进行配对,经SPSS统计分析软件进行T检验分析。结果消融前、后:HIS电图,A—ERP,A—FRP,V—ERP,V—FRP,AVN—ERP,及VAN—WKB均无显著差异(P>0.05)。AVN—WKB,VAN—ERP有显著差异(P<0.05)。讨论射频消融房结改良对房室结双径路AVNRT疗效肯定。在消融前、后(急性期)房室结前、逆传电生理均有一定改变。这与消融改变了房室结的部分结构,如大部分病列慢径路消失有关。不同消融部位对房室结传导电理改变产生不同的结果。没有证据表明消融后,45岁以上年龄组房室结传导改变大于45岁以下年龄组。男女不同性别组之间亦无差异。 相似文献
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房室结双径路和房室结折返性心动过速的研究进展同济医科大学附属协和医院罗瑞萍综述于世龙审校房室结折返性心动过速(AVNRT)是阵发性室上性心动过速最常见的类型之一。房室结双径路(AVNDP)被认为是发生AVNRT的基础。近年,随着心内电生理检查及导管消... 相似文献
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为探讨射频导管消心室改良术所致心律失常的发生规律,分析射频导管消融房室结改良术22例术中及术后24h的心电监测资料,并与预激旁道消融术22例进行对比研究。 相似文献
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Arena G Bongiorni MG Soldati E Gherarducci G Mariani M 《Journal of cardiovascular electrophysiology》1999,10(12):1636-1642
In patients with dual AV nodal physiology, simultaneous anterograde fast and slow pathway conduction resulting in an unusual form of nonreentrant AV nodal tachycardia has been observed. We describe the case of a young patient with an incessant form of complex supraventricular tachycardia who underwent electrophysiologic evaluation, which showed simultaneous conduction via multiple AV nodal pathways that caused a unique form of incessant nonreentrant AV nodal tachycardia. Radiofrequency ablation of the spatially closed intermediate and slow pathways effectively treated the tachycardia. The electrophysiologic determinants of simultaneous conduction through the multiple nodal pathways and the apparently different behavior of the fast pathway before and after ablation are discussed. 相似文献
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射频消融慢径对房室结双径路患者房室结传导功能的影响 总被引:9,自引:0,他引:9
目的 初步探讨房室结双径路是的电生理联系,方法 对39例(男13例,女26例)平均年龄(46.6±16.4)岁的房室结哲返性心动过速患进行房室结慢径消融,观察慢径消融对房室结传导功能的影响。结果 成功率100%,26例消融后慢径消失(Ⅱ组)13例消融后慢径残存(Ⅱ组),消融前后I组房室结快径前传有效不应期由(332.5±49.5)ms缩短为(282.5±58.0)ms前传功能不应期由(382.9 相似文献
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中位法射频消蚀慢径路治疗房室结折返性心动过速 总被引:3,自引:0,他引:3
导管射频消蚀术(RFCA)治疗房室结折返性心动过速43例,采用"中位法"选择性阻断慢径路,该技术的关键是:①在X线右前斜位30度下,将消蚀电极置于冠状窦口和希氏束连线的中点附近;②消蚀电极双极记录到小A大V波;③放电时有交界性心律(包括快交界律、慢交界律、交界性早搏);④以间断放电和时间递增的方法控制消蚀过程;⑤消蚀终点为放电总累积时间达60~90秒,重复电生理检查证实慢径阻断或心动过速不能诱发。经1~3个部位的消蚀彻底阻断慢道36例,遗留慢径传导7例(有心房回波2例)。除1例术后第二天发生一过性Ⅲ°AVB,二周恢复正常外,余无并发症发生,随访3~24个月(平均14±6),停用任何抗心律失常药,无心动过速发作。消蚀成功率100%。认为“中位法”是消蚀房室结慢径路治疗房室结折返性心动过速的安全、简便和有效的方法,部分病例保留慢传导并不增加复发率。 相似文献
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Lin JL Huang SK Lai LP Lin LJ Chen JH Tseng YZ Lien WP 《Heart (British Cardiac Society)》2000,83(5):543-550
OBJECTIVE—To search for a reliable anatomical landmark within Koch's triangle to predict the risk of atrioventricular (AV) block during radiofrequency slow pathway catheter ablation of AV nodal re-entrant tachycardia (AVNRT).
PATIENTS AND METHODS—To test the hypothesis that the distal end of the AV nodal artery represents the anatomical location of the AV node, and thus could be a useful landmark for predicting the risk of AV block, 128 consecutive patients with AVNRT receiving slow pathway catheter ablation were prospectively studied in two phases. In phase I (77 patients), angiographic demonstration of the AV nodal artery and its ending was performed at the end of the ablation procedure, whereas in the subsequent phase II study (51 patients), the angiography was performed immediately before catheter ablation to assess the value of identifying this new landmark in reducing the risk of AV block. Multiple electrophysiologic and anatomical parameters were analysed. The former included the atrial activation sequence between the His bundle recording site (HBE) and the coronary sinus orifice or the catheter ablation site, either during AVNRT or during sinus rhythm. The latter included the spatial distances between the distal end of the AV nodal artery and the HBE and the final catheter ablation site, and the distance between the HBE and the tricuspid border at the coronary sinus orifice floor.
RESULTS—In phase I, nine of the 77 patients had complications of transient (seven patients) or permanent (two patients) complete AV block during stepwise, anatomy guided slow pathway catheter ablation. These nine patients had a wider distance between the HBE and the distal end of the AV nodal artery, and a closer approximation of the catheter ablation site to the distal end of the AV nodal artery, which independently predicted the risk of AV block. In contrast, none of the available electrophysiologic parameters were shown to be reliable. When the distance between the distal end of the AV nodal artery and the ablation target site was more than 2 mm, the complication of AV block virtually never occurred. In phase II, all 51 patients had successful elimination of the slow pathways without complication when the ablation procedure was guided by preceding angiography with identification of the distal end of the AV nodal artery.
CONCLUSIONS—The distal end of the AV nodal artery shown by angiography serves as a useful landmark for the prediction of the risk of AV block during slow pathway catheter ablation of AVNRT.
Keywords: atrioventricular nodal artery; atrioventricular nodal re-entrant tachycardia; catheter ablation; heart block. 相似文献
PATIENTS AND METHODS—To test the hypothesis that the distal end of the AV nodal artery represents the anatomical location of the AV node, and thus could be a useful landmark for predicting the risk of AV block, 128 consecutive patients with AVNRT receiving slow pathway catheter ablation were prospectively studied in two phases. In phase I (77 patients), angiographic demonstration of the AV nodal artery and its ending was performed at the end of the ablation procedure, whereas in the subsequent phase II study (51 patients), the angiography was performed immediately before catheter ablation to assess the value of identifying this new landmark in reducing the risk of AV block. Multiple electrophysiologic and anatomical parameters were analysed. The former included the atrial activation sequence between the His bundle recording site (HBE) and the coronary sinus orifice or the catheter ablation site, either during AVNRT or during sinus rhythm. The latter included the spatial distances between the distal end of the AV nodal artery and the HBE and the final catheter ablation site, and the distance between the HBE and the tricuspid border at the coronary sinus orifice floor.
RESULTS—In phase I, nine of the 77 patients had complications of transient (seven patients) or permanent (two patients) complete AV block during stepwise, anatomy guided slow pathway catheter ablation. These nine patients had a wider distance between the HBE and the distal end of the AV nodal artery, and a closer approximation of the catheter ablation site to the distal end of the AV nodal artery, which independently predicted the risk of AV block. In contrast, none of the available electrophysiologic parameters were shown to be reliable. When the distance between the distal end of the AV nodal artery and the ablation target site was more than 2 mm, the complication of AV block virtually never occurred. In phase II, all 51 patients had successful elimination of the slow pathways without complication when the ablation procedure was guided by preceding angiography with identification of the distal end of the AV nodal artery.
CONCLUSIONS—The distal end of the AV nodal artery shown by angiography serves as a useful landmark for the prediction of the risk of AV block during slow pathway catheter ablation of AVNRT.
Keywords: atrioventricular nodal artery; atrioventricular nodal re-entrant tachycardia; catheter ablation; heart block. 相似文献
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房室结功能曲线连续性房室结折返性心动过速患者的射频消融终点初探 总被引:1,自引:0,他引:1
目的 探讨房室结功能曲线连续性房室结折返性心动过速 (AVNRT)患者的射频消融终点。方法 在AVNRT患者中 ,对心房 A1 A2 和 A1 A2 A3程序刺激房室结功能曲线均呈连续性者为 组 ,A1 A2 刺激房室结功能曲线呈连续性而 A1 A2 A3刺激呈不连续性者为 a组 ,房室结功能曲线均呈不连续性者为 b组。行慢径区域消融后 ,对组间的电生理参数进行比较。结果 组非典型 AVNRT的诱发率高于 组 (2 7.3 % vs5 .6% ,P<0 .0 5 )。在 I组和 a组 ,消融后最长 A2 H2 间期 (A2 H2 m ax)均比消融前有所缩短 ,但无显著性差异 (P>0 .0 5 ) ,而 b组则显著缩短 (3 76± 73 ms vs2 0 6± 5 6ms,P<0 .0 1)。消融后 组、 a组和 b组的最长 A3H3间期 (A3H3m ax)均比消融前显著缩短 (2 74± 71ms vs 196± 45 ms,P<0 .0 5 ;3 62± 91m s vs 2 2 6± 72 m s,P<0 .0 1;3 85± 88ms vs 2 19± 61ms,P<0 .0 1)。结论 非典型 AVNRT与房室结功能曲线的连续性有关。对于房室结功能曲线连续性的 AVNRT患者 ,消融后 A3H3max的缩短可作为消融终点的指标之一 相似文献
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房室折返性心动过速合并房室结双径现象 总被引:5,自引:0,他引:5
目的 分析射频消融术证实的房室帝道(AP)合并房室结双径(DAVNP),以了解其电生理特点。方法 以食管心房调博及心内电生理检查,确诊室上速合并房室结双径12例,并行射频消融枚。结果 AP合并DAVNP占AP的16.4%(12/73),多为陷匿性AP(10/12),其折返途径多为AP逆传(10/12),房室结单一径路前传,房室结快径道不应期及心动过速时RP’(VA)与RP意期,在食道电生理与心内电 相似文献
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目的 探讨快速、准确标测左侧斜行旁道消融靶点的方法,提高导管消融成功率。方法 对66例AVRT患者在高位右心房刺激、心室刺激或室性期前收缩、诱发室上性心动过速及窦性心律时进行心腔内电生理检查,确定旁道的走行方向,标测心室及心房侧靶点图,记录消融靶点位置及消融时间。结果 发现6例旁道走行方向斜跨二尖瓣环并确定为斜行旁道,经主动脉逆行法最终全部消融成功,部分病例耗时较长。结论 如果冠状窦标测电极(CS)记录到的最早逆行心房激动点和最早顺传心室激动点不在同一记录直线上,在排除多旁道后应考虑斜行旁道的可能,同时可判断其斜行程度。最早逆行心房激动点和最早顺传心室激动点分别是心房侧和心室侧的消融靶点。如能标测到旁道电位,成功率更高。对于隐匿性左侧旁道,左心室起搏信号s到cs上最早逆传至A波的最短间隔处是很好的消融靶点。 相似文献
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Yokoshiki H Sasaki K Shimokawa J Sakurai M Tsutsui H 《Journal of electrocardiology》2006,39(4):395-399
We report a case of complex supraventricular tachycardia manifested by radiofrequency delivery. Initially, the patient presented with orthodromic atrioventricular reentrant tachycardia via a left-sided accessory pathway that was successfully eliminated. Atrial tachycardia originating from coronary sinus ostium was also induced. Radiofrequency delivery at the coronary sinus ostium induced a narrow QRS tachycardia with irregular R-R intervals. A detailed analysis explained that the tachycardia could be a nonreentrant mechanism due to triple atrioventricular nodal pathways: an atrial excitation evokes double ventricular response due to simultaneous activation of the fast and slow pathways, and the next one activates ventricle through the intermediate pathway. 相似文献
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房室结内折返性心动过速慢径路消融中房室传导阻滞的预防 总被引:2,自引:0,他引:2
目的 探讨房室结内折返性心动过速(AVNRT)慢径路消融中房室传导阻滞的预防措施。方法 72例AVNRT患者从小功率(5W)开始放电,逐步增加放电功率,根据放电时的反应,及时改换安全的放电部位;放电过程中不苛求房室交接区心律从有到无的规律;慢径路改良,不苟求慢径路消失,以不诱发心动过速为宗旨。结果 72例慢径路消融均成功,无一例发生房室传导阻滞的并发症,无一例远期复发。结论 从小功率开始放电,慢径路改良等措施,可有效预防房室传导阻滞,且对远期复发无影响。 相似文献
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射频消融治疗房室结折返性心动过速不同终点的疗效观察 总被引:1,自引:0,他引:1
目的 评价射频消融治疗房室结折返性心动过速 ( AVNRT)的不同终点对远期复发的影响。方法 对 1 0 4例 AVNRT患者进行慢径消融 ,比较慢径传导消失组和慢径传导残留组 AVNRT复发率。结果 射频消融术后慢径传导消失 5 8例 ,慢径传导残留 4 6例 ,术后 1 8± 9个月随访期内 ,慢径传导消失组复发 2例 ( 3 .4 % ) ,慢径传导残留组复发 2例 ( 4.3 % ) ,两组无显著差别 ( P>0 .0 5 )。结论 射频消融术后慢径传导残留并不增加 AVNRT复发的危险性 相似文献