经导管射频电消蚀治疗房室结折返性心动过速的疗效观察

采用射频电消蚀(RFCA)对14例房室结双径路(AVNDP)合并房室结折返性心动过速(AVNRT)患者进行房室结改良术.结果是,13例房室结双径路电生理特征及房室结折返性心动过速诱发窗口消失,成功率达92.8%(13/14),无严重并发症.随访l～12月,2例复发.表明采用RFCA治疗AVNRT效果良好,且无副作用.     

房室结双径路和房室结折返性心动过速的研究进展

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...     

射频消融治疗儿童房室结折返性心动过速

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     

射频消蚀阻断慢径路治疗房室结折返性心动过速（摘要）

射频消蚀阻断慢径路治疗房室结折返性心动过速（摘要）吴书林，李海杰，欧阳非凡，郑祥生，尹滔业，孙家珍，冯建章２０例径食管心房调搏等临床检查诊断为房室结折返性心动过速病人，男５女１５，平均年龄４８．４（２２～６７）岁，心动过速发作史２１．３（２～５０）年...     

房室结改良法射频消蚀治疗房室折返性心动过速初探（附二例报告）

按常规方法射频消蚀（ＲＦＣＡ）治疗房室折返性心动过速（ＡＶＲＴ），二例右侧隐匿性旁道未阻断。改用下位法改良房室结（ＡＶＮ），在Ｈ波完全消失处放电。结果：延长了正向房室传导有效不应期（ＥＲＰ），ＡＶＲＴ不能诱发。提示：ＡＶＮ改良法可作为ＲＦＣＡ治疗ＡＶＲＴ的补充方法。     

房室结双径路参与的房室折返性心动过速

患者男性,38岁。有阵发性室上性心动过速(室上速)史10余年,近2年发作频繁,室上速发作时各种抗心律失常药物均不能直接终止,每次均需食管调搏超速或亚速刺激方可终止。此次因心悸5ｈ就诊。查体:神志清晰,血压12080ｍｍＨｇ(1ｍｍＨｇ=0133ｋＰａ),心率190次ｍｉｎ,律齐,各瓣膜听诊区未闻杂音。心动过速发作时心电图如图1所示。ＱＲＳ波形为室上性,在Ｖ1导联呈ＱＳ型,时限008ｓ,频率190次ｍｉｎ。ＲＲ间期长短交替,分别为320ｍｓ和270ｍｓ。食管导联可见Ｐ′波在ＱＲＳ波群之后,ＲＰ′间期固定,为012ｓ,Ｐ′波形态一致。Ｐ′Ｒ间期则长短交替,…     

射频消融治疗房室结双径路心动过速

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.     

房室结折返性心动过速与房室结双径路的相关性研究

目的　探讨房室结折返性心动过速 (AVNRT)与房室结双径路 (DAVNP)的相关性。方法　回顾性分析成功射频导管消融的单一类型 AVNRT的心内电生理和食管心房调搏 (GEAP)资料。结果　10 7例单一类型的 AVNRT,存在 DAVNP者 10 1例 ,其中慢 -快型 AVNRT99例 ,慢 -慢型 AVNRT2例 ;DAVNP阴性者 6例 ,其中慢 -快型 AVNRT1例 ,慢 -慢型 AVNRT3例 ,快 -慢型 AVNRT2例 ;慢 -快型 AVNRT DAVNP阳性检出率明显高于慢 -慢型和快 -慢型 AVNRT(P<0 .0 1)。 10 0例慢 -快型AVNRT中 ,5 8例女性较 42例男性年轻 (4 2 .0± 12 .9比 49.6± 11.8,P<0 .0 1) ,分别有 11例和 10例心内电生理检查时 DAVNP阴性 ,而 TEAP存在 DAVNP。结论　 DAVNP是慢 -快型 AVNRT的发生基础 ,而慢 -慢型和快 -慢型 AVNRT与 DAVNP的相关性较差。     

房室结双径路与房室结折返性心动过速的研究概况

房室结双径路是引起房室结折返性心动过速的基础 ,目前房室结双径路的解剖仍是争论的焦点 ,本文通过对房室结双径路的解剖与电生理特征一般研究概况和最新进展的探讨 ,进一步理解房室结折返性心动过速的有关类型 ,明确射频消融治疗存在的问题。为研究提供思路。     

辅用SR_0长鞘在慢径路消融治疗房室结折返性心动过速价值探讨

目的　探讨辅用ＳＲ０ 长鞘在慢径路消融治疗房室结折返性心动过速（ＡＶＮＲＴ）中的应用价值。方法　应用复合定位法慢径路消融治疗１７４ 例典型ＡＲＮＲＴ 患者,未用长鞘与辅用长鞘组各８７ 例。比较两组消融结果。结果　辅用长鞘组较对照组手术时间（６８±１７ ｍ ｉｎ ｖｓ ８５±２１ ｍ ｉｎ,Ｐ＜ ０．０１）,Ｘ 线曝光时间（１４±１６ ｍ ｉｎ ｖｓ １８±９ ｍ ｉｎ,Ｐ＜ ０．０５）,放电次数（３．２±２．５ ｖｓ ５．３±３．４,Ｐ＜ ０．０１）均显著减少。且辅用长鞘组８７ 例中,消融后慢径路消失者较多（５７ 例,６６％ ｖｓ ３９ 例,４５％ ,Ｐ＜ ０．０１）。结论　慢径消融中辅用ＳＲ０ 长鞘有明显应用价值     

房室结折返性心动过速冷冻消融与射频消融治疗对比分析

目的 探讨经导管冷冻消融与射频消融治疗房室结折返性心动过速的有效性和安全性.方法 对304例房室结折返性心动过速行导管消融术病例行回顾性分析,其中冷冻组67例,射频组237例,比较两组成功率、慢径完全阻断率、房室传导阻滞率和复发率的差异.结果 两组消融成功率(冷冻组98.5%与射频组97.0%,P=0.820)、慢径完全阻断率(冷冻组98.5%与射频组91.6%,P=0.088)、房室传导阻滞率(冷冻组0与射频组2.5%,P=0.413)、复发率(冷冻组0与射频组1.7%,P=0.643)差异均无统计学意义,但冷冻组慢径完全阻断率有优于射频组的趋势.结论 冷冻消融治疗房室结折返性心动过速安全有效,较射频消融术有潜在优势.

Abstract：

Objective To compare the efficacy and safety between cryoablation (Cryo) and radiofrequency (RF) ablation for treating patients with atrioventricular nodal reentrant tachycardia (AVNRT). Methods Patients with AVNRT (n=304) were divided into Cryo group (n=67) and RF group (n=237). The procedure success rate, complete slow pathway block rate, atrioventricular block rate and relapse rate were compared between two groups. Results There was no statistically difference between 2 groups in the success rate (Cryo group 98.5% vs RF group 97.0%, P=0.820), complete slow pathway block rate (Cryo group 98.5% vs RF group 91.6%, P=0.088), atrioventricular block rate (Cryo group 0 vs RF group 2.5%, P=0.413), relapse rate (Cryo group 0 vs RF group 1.7%, P=0.643). But Cryo group had more advantage than RF group. Conclusion Efficacy and safety were comparable between cryoablation and radiofrequency ablation for treating patients with AVNRT.     

房室折返性心动过速合并房室结双径现象

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     

在二尖瓣环成功消融房室结折返性心动过速

目的分析需要在二尖瓣环消融的房室结折返性心动过速(AVNRT)的电生理特点。方法采用重整标测方法(resetting)在二尖瓣环判断慢径位置并进行射频消融,观察在二尖瓣环消融成功的AVNRT相关的电生理参数。结果3例既往消融失败的AVNRT患者在右侧常规慢径区域消融仍不成功,在消融中仅1例偶尔出现交界性逸搏心律;改在二尖瓣环行重整标测可以确定慢径位置,在消融中均间断出现交界性逸搏心律,且消融均获成功。结论对于难治性AVNRT,可能需要在二尖瓣环消融,重整标测有助于确定慢径位置。     

Cryothermal slow pathway modification for atrioventricular nodal reentrant tachycardia.

AIMS: Predictors of recurrence following transcatheter cryoablation for atrioventricular nodal reentrant tachycardia (AVNRT) are currently unknown. Our objective was to explore predictors of recurrence post-cryoablation for AVNRT, including the impact of procedural endpoints such as complete elimination of slow pathway conduction vs. persistent dual atrioventricular (AV) nodal physiology with or without echo beats. METHODS AND RESULTS: A single center cohort study was performed on patients undergoing a first cryoablation procedure for AVNRT between May 1999 and December 2004. Cryoablation for AVNRT was attempted in 185 consecutive patients (79.2% female), age 43.1 +/- 15.2 years. Acute success was achieved in 170 (91.9%) patients with 4.4 +/- 3.5 cryoapplications and a total procedural duration of 2.8 +/- 0.8 h. Complete elimination of slow pathway conduction was noted in 47.6% of acutely successful interventions, absence of AV nodal echoes despite dual AV nodal physiology in 8.8%, and presence of echoes but no inducible AVNRT on and off isoproterenol in 43.5%. Actuarial recurrence-free survival following acutely successful cryoablation at 1, 3, 6, 12, and 24 months was 94.8, 93.1, 91.7, 90.8, and 90.8%, respectively. Independent predictors of recurrence were younger age (P = 0.0045) and valvular heart disease (P = 0.0186). The achieved procedural endpoint did not modulate recurrence rates. Eight patients (4.3%) experienced transient third degree AV block; none required permanent pacing. CONCLUSIONS: As a cryoablation procedural outcome for AVNRT, persistent dual AV nodal physiology with or without echo beats is not associated with higher recurrence rates than complete elimination of dual AV nodal physiology if AVNRT remains non-inducible on and off isoproterenol.     

Temperature-controlled slow pathway ablation for treatment of atrioventricular nodal reentrant tachycardia using a combined anatomical and electrogram guided strategy

AIMS: Anatomical and electrogram-guided techniques have been usedseparately for slow pathway ablation in atrioventricular nodalreentrant tachycardia. The aims of the present study were toanalyse electrogram characteristics of target sites and biophysicalparameters using a combined anatomical and electrogram-guidedtechnique for temperature-controlled radiofrequency catheterablation of the slow pathway. METHODS AND RESULTS: Using a temperature-controlled (pre-selected 60 °C) cathetersystem, 53 patients with atrioventricular nodal reentrant tachycardiaunderwent slow pathway radiofrequency ablation. Mapping wasstarted posteroseptally near the coronary sinus ostium and continuedtowards the midseptal area if needed. The longest and latestatrial electrograms with an atrioventricular ratio of 0·5were targeted. After a median of two pulses (mean 2·36± 1·33), atrioventricular nodal reentrant tachycardiawas rendered non-inducible in all patients without complications.Successful sites had longer atrial electrograms (78·8± 9·8 vs 67·6 ± 13·3 ms,P<0·003) and larger ventricular electrogram amplitudes(92·4 ± 51·2 vs 63·1 ± 28·8mV, P<0·05) than the failed sites, but had a similaratrioventricular ratio, P-A interval and atrial electrogramamplitude. Overall, an atrial electrogram duration of 70 mswas associated with effective radiofrequency delivery, with86% sensitivity and 62% specificity. The achieved temperaturemaximum was 62·3 ± 9·8 °C at successfuland 58·8 ± 9·0 °C at unsuccessful sites(ns). There was no significant difference between successfuland unsuccessful applications with respect to power output,impedance and total delivery energy. During a pre-dischargestudy, three patients with inducible atrioventricular nodalreentrant tachycardia underwent a repeat ablation. During 12·3± 2·5 (6–15) months of follow-up, threeothers had a clinical recurrence of atrioventricular nodal reentranttachycardia. CONCLUSIONS: The combined approach for slow pathway ablation is highly effective,requiring a low number of radiofrequency pulses. Long atrialactivation time seems to be the most powerful predictor of success.Similar catheter tip temperature levels during successful andunsuccessful radiofrequency applications indicate that suboptimalselection of target sites rather than ineffective heating dueto poor catheter tissue coupling is responsible for unsuccessfulenergy delivery.     

Atrioventricular nodal reentrant tachycardia with ventriculoatrial block and unsuccessful ablation of the slow pathway

We report the case of failed slow pathway ablation in a woman with typical AV nodal reentrant tachycardia (AVNRT) and periods of Wenckebach-like second-degree VA block and 2:1 VA block. The occurrence of VA block during AVNRT suggests the upper turnaround point of the circuit is confined to the AV node. This supports the notion that, at least in some cases, the location of the reentrant circuit for AVNRT is completely in the compact AV node.     

Acute coronary artery stenosis during slow pathway ablation for atrioventricular nodal reentrant tachycardia in a child

Coronary injury during radiofrequency ablation is a rare but n. potentially life-threatening complication that has been reported for attempted elimination of accessory pathways. This is the first report of coronary artery injury during slow pathway ablation for AV nodal reentrant tachycardia. Manifest signs of injury may be transient or nonexistent and easily missed. Controlled studies are needed to determine the true risk of coronary artery injury during radiofrequency ablation for supraventricular tachycardia, particularly in small children.     

房室结折返性心动过速的可能折返机制和分型及其在指导慢径消融中的意义

目的根据房室结存在快径、右侧后延伸（经典慢径）和左侧后延伸（另一条慢径）和折返环路,对房室结折返性心动过速（AVNRT）进行分型,并根据电生理检查和射频消融的结果验证以上分型,同时分析此分型在指导房室结慢径消融中的意义.方法 812例入院进行射频消融AVNRT患者,常规行程序心房和心室电刺激和心内标测.根据AVNRT的类型分别采用消融房室结前传慢径和/或逆传慢径的方法治疗AVNRT.结果采用目前常用的AVNRT的分型方法,812例AVNRT患者中,慢快型659例（81%）、慢慢型81例（10%）、快慢型72例（9%）.所有812例AVNRT患者均消融或改良房室结慢径成功.按AVNRT可能的6种折返环路分型,慢快型649例（80%）、左侧变异慢快型10例（1%）、快慢型和变异快慢型57例（7%）、左侧变异快慢型15例（2%）、慢慢型81例（10%）.结论按房室结快径、右侧后延伸和左侧后延伸可能形成的6条折返环路,对AVNRT进行分型,符合电生理检查和射频消融的结果.此分型对理解AVNRT的折返机制和指导房室结慢径消融治疗AVNRT有较大的意义.     

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

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