导管射频消融治疗房性心动过速的体会

总结５例房性心动过速的电生理特点，探讨提高导管射频消融成功率的标测与消融方法。男１例、女４例，平时心电图正常，心动过速发作时心室率１５０～２２０ｂｐｍ，ＲＰ＞ＰＲ。大头电极在右房内标测到最早的心房激动点，在心动过速时放电。２例在冠状窦口附近、２例在右房侧壁（双大头法标测）消融成功，靶点局部电位较体表心电图的Ｐ波提前２９ｍｓ以上；１例窦房折返性心动过速，消融失败。结果表明：激动标测是最基本的方法，结合拖带或隐匿性拖带、起搏标测、机械阻断等选择靶点的方法可以提高成功率；适当选择双大头法标测能够缩短手术时间。

Experience on the Treatment of Atrial Tachycardia by Radiofrequency Catheter Ablation

The electrophysiological characteristics of five cases atrial tachycardia(AT) during radiofrequency catheter ablation(RFCA) were analyzed to investigate the method of mapping and ablation for promoting the successful rate.Four females and one male had the history of tachycardia from 2 to 3 years.During tachycardia,their heart rates were 150～220 bpm,RP>PR.One or two 8 F Braided 4 mm tipped ablating catheters were inserted into right atrial through right femoral vein to map the earliest activating point.25～30 W radiofrequency current were discharged during tachycardia.Two cases AT near the coronary sinus orifice and 2 at the lateral wall of right atrial were successfully ablated,their targets had local fragmented potential which were 29 milisecond or more before the P wave of electrocardiogram.One with sinus atrial reentrant tachycardia failed.Activation mapping is the essential method for ablating AT.With the aid of entrainment or conceal entrainment,pacing mapping,mechanical interrupting,the successful rate of ablating AT can be improved.The selection of two large tipped catheter for mapping can shorten the time of RFCA in proper cases.