阵发性心房扑动-心房颤动电生理检查和射频消融治疗

对经选择的阵发性心房扑动－心房颤动患,在三尖瓣环－下腔静脉峡部进行射频消融,探讨这类房性快速心律的电生理特点和治疗效果。方法１０例频繁发作ＡＦＦＬ患与同期１０例Ⅰ型心房扑动,经心内电生理检查并按解剖部位进行ＲＡＩＳ线性消融。结果右房上及冠状静脉窥口有效不应期,在ＦＦＬ中均短于ＡＦ,房内传导时间亦较ＡＦ为延长。

Electrophysiologicalproperties and the effect of ablation on paroxysmal atrial flutter-fibrillation patients

Objective　To test the occurrence of atrialflutter-atrial fibrillation (AFFL) in at least some patients is based on macro-reentryaround right atrium tricuspid valve orifice, including tricuspid-IVC-isthmus (RAIS), andto evaluate the effect of radiofrequency ablation (RFCA) of AFFL on RAIS. Methodsand Results　Tendrug-resistant paroxysmal AFFL patients together with 10 atrial flutter (AF) patientsunderwent EPS and RFCA on the RAIS. The ERP of HRA and CSO were shorter, and with longerinter-atrial conduction time in AFFL than in AF. Right atrial AF and left atrial “organized atrial fibrillation” revealed in all AFFL patients.AF and fibrillation were coexisting and alternating during the test. Follow-up for 3-36(average 18.6±14.2) months after ablation, 3 (30%) cases remained in sinus rhythm, theother 6 cases remained in sinus rhythm on average 5.8±3.7 months, therefore during anaverage of 6 months, 90% cases were in sinus rhythm. 6 cases recurred after an average of6 months, but paroxysms were significantly reduced or could be controlled by originallyineffective drugs. Conclusion　The effect of RFCA on AFFL suggests that AFFL might be anintermediate stage between AF and fibrillation. RAIS may play an important role in theinitiation or maintenance of this type of arrhythmia. Further classifications of atrialfibrillation are in necessity for selection of indicated patients for ablation.