超声引导下实施射频消融房室结安置VVI起搏器初步探讨

探索经胸心脏超声引导心内射频消融房室结的可行性和安全性。对11例持续/永久性心房颤动/心房扑动拟行房室结消融加VVI起搏,在经胸心脏彩超引导下,采取多切面观察、导管运动中观察,密切结合心内电生理定位,尝试左锁骨下静脉永久起搏导管和右股静脉消融导管的心内定位和靶点消融。以出现稳定的房室分离判为消融成功。结果:11例房室结消融及VVI起搏均顺利完成,手术时间70～180min,放电期间超声切面可见能量释放征,消融后靶点区心内膜回声明显增强。手术成功率100%,随访期内患者恢复良好。结论:经胸切面超声引导射频消融房室结安置VVI起搏安全、简便、可行、经济。

The Use of Transthoracic Echocardiography in Radiofrequency Catheter Ablation of Atrioventricular Node and VVI Pacemaker Implantation

Evaluating the value of transthoracic echocardiography(TTE) in guiding the radiofrequency catheter ablation(RFCA) of atrioventricular node(AVN). During RFCA of AVN and VVI pacing for 11 patients with persistent or permanent atrial fibrillation/atrial flutter, electrode catheter positioning and target melting were guided by TTE with multi-view observation and dynamic observation. The success of ablation was determined by emergence of stable atrial ventricular dissociation. Results: TTE successfully guided AVN ablation and zpermanent pacemaker implantation in 11 patients, with 100% operation success rate without X-ray exposure. Signs of power release could be seen in the ultrasonic section during discharging. After successive ablation, endocardium echo in the target zone increased obviously. Operation duration varied from 70 to 180 min, without death and other serious complications. Conclusions: TTE is very safe, easy, feasible and economical in guiding atrioventricular node ablation and VVI pacemaker implantation.