三维标测系统指导下近似零曝光射频消融治疗阵发性室上性心动过速的围术期护理

目的总结室上性心动过速(PSVT)病人EnSite NavX标测指导下行射频消融(RFCA)治疗的围术期护理。方法对28例PSVT病人(包括房室结折返性心动过速、房室折返性心动过速、心房扑动和房速)EnSite NavX标测指导下行RFCA治疗,除了心律失常均无其他慢性器质性心脏疾病史。加强术前准备和心理护理,术后监测生命体征、观察肢体供血及穿刺部位情况、并发症的观察等。结果 28例病人均手术成功,术后无复发及并发症。结论加强PSVT病人EnSite NavX标测指导下RFCA治疗的围术期护理是手术成功的重要保证,且显著减少了患者的曝光时间。     

阵发性室上性心动过速的射频消融治疗

[目的]探讨射频消融术（RFCA）治疗阵发性室上性心动过速（PSVT）的安全性和成功率。【方法】回顾分析RFCA治疗PSVT101例的疗效；101例中包括房室间折返性心动过速（AVRT）48例，左侧旁道38例，右侧旁道10例，房室结折返性心动过速（AVNRT）53例。均先行心内电生理检查确定心动过速类型和消融靶点。【结果】总成功率100％（101／101例），总复发率0．99％（1／101例），再次RFCA获得成功。2例发生Ⅲ度房室传导阻滞，发生率1．98％（2／101），1例发生左侧气胸（左上肺受压约30％）于RFCA术后一周自然吸收，发生率o．99％（1／101）。【结论】根据设备条件严格掌握适应证，消融前进行系统电生理检查，旁道消融靶点正确标测，放电中Ⅲ度房室传导阻滞的识别和消融终点正确判定是提高安全性和成功率的关键。     

射频消融治疗阵发性室上性心动过速303例分析

目的；回顾分析我院2006年303例阵发性室上性心动过速（PSVT）患者的电生理机制特点、射频消融术（RFCA）治疗的有效性与安全性。方法：入选我院近1a内的射频消融（RFCA）治疗阵发性室上性心动过速（PSVT）303例，均先行电生理检查确定PSVT的类型和消融靶点，并成功实施RFCA治疗。结果：经电生理证实，在303例PSVT患者中，房室折返性心动过速（AVRT）占53．14％、房室结折返性心动过速（AVNRT）45．54％、预激综合征14．85％，AVRT与AVNRT并存者占1．32％。RFCA治疗的总成功率100％，并发症发生率1．98％，其中气胸发生3例，心包填塞1例，假性动脉瘤1例，无一例因并发症死亡。结论：AVRT、AVNRT是PVST的主要机制。RFCA是治疗PSVT的有效方法。术者的熟练程度、消融靶点的位置、患者的配合等是减少术后并发症的主要因素。     

阵发性室上性心动过速170例射频消融术后制动的护理

我科对阵发性室上性心动过速170例行射频消融术患者的制动进行整体的护理，取得了很好的效果。护理体会如下。1临床资料本组男98例，年龄5～76岁；女72例，年龄11～75岁。其中左侧旁路80例，右侧旁路18例，双径路72例。本组均无器质性心脏病，均采用射频消融术治疗，均成功，对术后患者制动进行整体护理，结果发生尿潴留1例，进行无菌导尿；无低血压发生；厌食3例，床上活动后缓解；便秘1例，给予开塞露1支肛塞解除便秘；腰背酸痛不适12例，给予实施护理后能耐受；焦虑3例，给予心理护理能缓解；无血栓形成。     

经导管射频消融治疗阵发性室上性心动过速的护理

目的:探讨射频消融术患者的护理方法。方法:分析总结我科应用射频消融术治疗阵发性室上性心动过速185例的临床资料。结果:185例患者中,179例1次手术成功,6例房室结双径路患者第1次手术后阵发性室上性心动过速(PSVT)复发,其中4例因PSVT频繁发作行第2次手术,术后未再复发。仅3例患者出现穿刺部位血肿,后逐渐自行吸收。结论:对射频消融术治疗的患者加强护理与观察,减轻患者的心理负担,有利于减少并发症,保证手术的顺利进行,提高成功率。     

低功率射频消融治疗室上性心动过速的疗效观察

目的探讨低功率射频消融治疗室上性心动过速的疗效及安全性.方法对24例室上性心动过速患者,其中房室结双通道9例,房室旁道15例,采用低功率消融.结果24例均消融成功,无严重并发症,随访1年均无复发.结论低功率射频消融室上性心动过速疗效高,安全性好,无严重并发症.     

低功率射频消融治疗室上性心动过速的疗效观察

目的 探讨低功率射频消融治疗室上性心动过速的疗效及安全性。方法 对24例室上性心动过速患者，其中房室结双通道9例，房室旁道15例，采用低功率消融。结果 24例均消融成功，无严重并发症，随访1年均无复发。结论 低功率射频消融室上性心动过速疗效高，安全性好，无严重并发症。     

射频消融治疗阵发性室上性心动过速176例疗效观察

我院自1997年开展射频导管消融术以来。治疗阵发性室上性心动过速(PSVT)176例，效果满意，总结如下。     

阵发性室上性心动过速经导管射频消融术的临床护理

目的 探讨经导管射频消融术（RFCA）治疗阵发性室上性心动过速（PSVT）的临床护理措施。方法 回顾分析106例阵发性室上性心动过速经导管射频消融术的治疗和护理资料。结果 通过医护合作，提高了消融成功率，心理护理消除了患者的恐惧心理，减少了术中、术后的并发症。结论 护理是保证射频消融治疗阵发性室上性心动过速成功的重要组成部分。     

三维电生理导航系统指导下导管射频消融术治疗阵发性室上性心动过速的效果及安全性

目的分析三维电生理导航系统(Carto3)指导下导管射频消融术(RFA)治疗阵发性室上性心动过速(PSVT)的效果及安全性。方法将我院收治的64例PSVT患者按手术方案不同分为研究组与参照组,各32例。研究组给予Carto3指导下导管RFA,参照组给予X线透视下常规消融法。比较两组的消融成功率、临床相关指标及并发症发生率。结果研究组消融成功率为96.88%,高于参照组的81.25%(P<0.05);研究组的肺静脉定口时间、环肺静脉消融时间、X线辐射时间均短于参照组(P<0.05)。两组的并发症总发生率比较,差异无统计学意义(P>0.05)。结论Carto3指导下导管RFA治疗PSVT患者可提高消融成功率,缩短肺静脉定口时间、环肺静脉消融时间、X线辐射时间。     

射频消融治疗不能诱发的室上性心动过速患者的远期效果

目的探讨导管射频消融慢径路在具有房室结双径路和有记录的不能诱发的室上性心动过速(PSVT)患者中的作用。方法在基础状态或静脉应用异丙肾上腺素后,对49例不能诱发PSVT患者(A组)给以程控电刺激,13例可诱发单次房室结回波,9例诱发了两次回波;与49例年龄、性别匹配的可诱发PSVT的患者(B组)进行临床和电生理特征的对比。结果两组患者的快、慢径路的电生理特性无明显差异,射频消融在所有患者中都阻断了慢径路。在随访的(38±5)个月中,两组均未再次发作。结论在具有房室结双径路的有记录的不能诱发的PSVT患者中,导管射频消融慢径路在长期预防心动过速时是有效的。     

The results of radiofrequency catheter ablation of supraventricular tachycardia in children

BACKGROUNDS: Radiofrequency (RF) catheter ablation represents a major advance in the management of children with cardiac arrhythmias and has rapidly become the standard of care for the first-ling therapy of supraventricular tachycardias (SVTs). The purpose of this study was to investigate the results of the RF catheter ablation of SVTs in pediatric patients. METHODS: From December 1989 to August 2005, a total of 228 pediatric patients (age: 9 +/- 7 years, range: 5-18 years; male:female = 117:111) with clinically documented SVT underwent an electrophysiologic study and RF catheter ablation at our institution. RESULTS: The arrhythmias included atrioventricular reentrant tachycardia (AVRT; n = 140, 61%), atrioventricular nodal reentrant tachycardia (AVNRT; n = 66, 29%), atrial tachycardia (AT; n = 11, 5%), and atrial flutter (AFL; n = 11, 5%). The success rate of the RF catheter ablation was 92% for AVRT, 97% for AVNRT, 82% for AT, and 91% for AFL, respectively. Procedure-related complications were infrequent (8.7%; major complications: high grade AV block (2/231, 0.9%); minor complications: first degree AV block (6/231, 2.6%), reversible brachial plexus injury (2/231, 0.9%), and local hematomas or bruises (10/231, 4.3%)). The recurrence rate was 4.7% (10/212) during a follow-up period of 86 +/- 38 months (0.5-185 months). CONCLUSIONS: The RF catheter ablation was a safe and effective method to manage children with paroxysmal and incessant tachycardia. The substrates of the arrhythmias differed between the pediatric and adult patients. However, the success rate of the ablation, complications, and recurrence during childhood were similar to those of adults.     

临床护理路径在室上性心动过速患者射频消融术中的应用

目的:探讨临床护理路径(CNP)在室上性心动过速(室上速)患者射频消融术(RFCA)中的应用效果.方法:将 100例室上速患者随机分为实验组和对照组各50例,对照组给予常规护理,实验组采取CNP进行护理.比较两组在康复时间、不良反应、并发症、患者满意度方面的差异.结果:实验组在卧床时间、住院时间、术后不良反应发生率、并发症发生率、患者满意度方面与对照组比较差异均有统计学意义(P<0.05).结论:将CNP应用于RFCA患者中,可缩短康复时间、提高患者满意度.     

Role of coronary angiography before radiofrequency ablation in patients presenting with paroxysmal supraventricular tachycardia

During episodes of paroxysmal supraventricular tachycardia (PSVT), electrocardiograms frequently show ST-segment depressions, and patients may experience typical chest pain prompting invasive coronary angiography. We evaluated 114 patients presenting with PSVT for concomitant coronary artery disease (CAD). Patients were classified as to the type of PSVT, symptoms during PSVT, and cardiovascular risk factors. Maximum heart rate, extent of ST-segment depression, and cardiac troponin levels during PSVT were recorded. Patients were subjected to exercise testing and/or coronary angiography. During PSVT, symptoms suggestive of myocardial ischemia, including chest pain (31%), ST-segment depression (61%), and elevated troponin levels (12%), were common. Sixty-seven patients (59%) underwent coronary angiography. The overall prevalence of significant CAD was found to be low (4%) and did not correlate to symptoms during tachycardia. Routine coronary angiography cannot be recommended in patients with PSVT unless routine evaluation outside episodes of tachycardia suggests the presence of significant CAD.     

Nonfluoroscopic catheter navigation for radiofrequency catheter ablation of supraventricular tachycardia in children

BACKGROUND: Radiofrequency catheter ablation (RCA) of supraventricular tachycardia (SVT) in children is highly successful but requires exposure to radiation. Nonfluoroscopic mapping systems may significantly reduce fluoroscopy time. METHODS: Forty consecutive pediatric patients who underwent RCA for accessory pathways (AP) or AV nodal reentrant tachycardia (AVNRT) with use of a nonfluoroscopic navigation system (Ensite NavX) (group A) were compared retrospectively to 40 consecutive patients with similar diagnoses who underwent RCA with fluoroscopic guidance only (group B). RESULTS: Group A (mean age 12.1+/-2.9 years, mean weight 47+/-13.9 kg) consisted of 11 patients (27.7%) with AVNRT and 29 (72.5%) with AP. Group B (mean age 10.9+/-3.1 years, mean weight 47.1+/-17.1 kg) consisted of 7 patients (17.5%) with AVNRT and 33 (82.5%) with AP. There were no significant differences in AP location, patients with congenital heart disease, and number of radiofrequency lesions. Fluoroscopy time was significantly shorter in group A than in group B (10.4+/-6.1, range 3.1-28.8 minutes, vs 24.9+/-16.0, range 4.4-82.0 minutes, P<0.0001). Procedure duration was also significantly shorter in group A than in group B (170+/-68.5, range 90-420 minutes, vs 218+/-69.3, range 90-360 minutes, P<0.0001). Initial success was 95% in group A and 100% in group B. Tachycardia recurrences occurred in two patients in group A (5%) and six patients in group B (15%). Final success, including repeat ablations for recurrences or failures, was 100% in both groups. CONCLUSIONS: The use of a nonfluoroscopic system for catheter navigation significantly reduced fluoroscopy exposure and total procedure duration of RCA of common SVT substrates in children.     

Reversible cardiomyopathy after radiofrequency ablation of lateral free-wall pathway-mediated incessant supraventricular tachycardia

Incessant supraventricular tachycardia leading to reversible cardiomyopathy has been reported. Cardiomyopathy usually only develops after prolonged episodes of tachycardia at a significant heart rate. Left ventricular free-wall pathways rarely cause fast and incessant tachycardia. Therefore cardiomyopathy has not been reported with left ventricular free-wall pathway-mediated supraventricular tachycardia. We report on two cases of left ventricular free-wall-mediated supraventricular tachycardia leading to reversible cardiomyopathy after radiofrequency ablation. These cases illustrate the difficulty in diagnosing tachycardia-mediated cardiomyopathy, as the tachycardia may be clinically silent. In addition, they emphasize the importance of making this diagnosis, as the cardiomyopathy is reversible.     

射频消融治疗阵发性室上性心动过速复发原因分析

目的：分析阵发性室上性心动过速患者行射频消融术后复发的原因，探讨降低术后复发的方法。方法：132例阵发性室上性心动过速患者，行射频消融术，术后每3～6个月随访1次，随访4～24个月。结果：132例患者中，复发10例，总复发率7．58％，其中房室结折返性心动过速复发率为6．52％，左侧房室旁路介导心动过速复发率5．89％，右侧旁路介导心动过速复发率14．28％。行射频消融术患者中，前70例复发率11．43％，后62例复发率3．22％。结论：精确的靶点标测、熟练的操作技巧以及消融方式的正确运用是降低射频消融术复发率的关键。     

Efficacy of radiofrequency catheter ablation in treatment of elderly patients with supraventricular tachyarrhythmias and ventricular tachycardia

Radiofrequency catheter ablation was performed in 100 men and 81 women, mean age 78 +/- 5 years, referred for ablation of atrial flutter, supraventricular tachycardia, and ventricular tachycardia, and for ablation of the atrioventricular junction with permanent pacemaker implantation in patients with atrial fibrillation and a rapid ventricular rate not controlled by drug therapy. A hematoma in 1 of 182 ablation procedures (<1%) was the only complication. Radiofrequency catheter ablation was successful in treating 63 of 70 patients (90%) with atrial flutter, in treating 60 of 66 patients (91%) with supraventricular tachycardia, in treating 2 of 2 patients (100%) with ventricular tachycardia, and in ablating the atrioventricular junction in 43 of 44 patients (98%) with atrial fibrillation and a rapid ventricular rate not controlled by drug therapy.