射频消融术后迟发性房室传导阻滞的评价和预防

目的(1)为提高射频消融手术的安全性,防止消融所致的迟发性房室传导阻滞。(2)评价射频消融延迟效应对手术效果及并发症的影响。方法随访在我院接受射频消融术34例患者发生一过性房室传导阻滞的时间及预后;对消融中发生一过性房室传导阻滞的34例患者采用分组对照,对照组在术后出现房室传导阻滞后予以治疗,治疗组早期预防性给予地塞米松治疗。结果6例患者分别于术后2d和1周内出现Ⅱ度Ⅰ型房室传导阻滞和持续Ⅲ度房室传导阻滞,对照组治疗后不能完全恢复正常;治疗组恢复正常,且随访6个月,动态心电图未显示房室传导阻滞。结论(1)对射频消融手术中出现一过性房室传导阻滞者早期 预防性给予地塞米松治疗可有效防止迟发性房室传导阻滞。(2)射频消融术后组织及电学损伤范围可进一步加大,从而产生延 迟现象。它可对患者有益也可产生不利影响,因此射频消融时要密切注意可能产生延迟反应的电生理现象。

Evaluation and prevention of delayed atrioventricular block after radiofrequency ablat ion

Objective (1) To increase the security of radiofrequency ablation and to prevent delayed atrioventricular block after radiofre-quency ablation;(2) To evaluate the effects of delayed block after ablation on operation effectiveness and complications.Methods The occurring time and prognosis of 34 cases present with interim atrioventricular block after ablation were followed up; The 34 cases were divided into two groups-control group (6 cases) and treatment group ( 28 cases).Atrioventricular block in control group was treated after ablation,while that in treatment group treated with dexamethasone immediately after ablation.Results Ⅱ°Ⅰ atrioventricular block and Ⅲ° atrioventricular block were observed from day 2 to day 7 in control group and they could not recover completely after treatment.Whereas they recovered to normal in treatment group; moreover,after followed up for 6 month,ECGs showed no atrioventricular block.Conclusion (1) Dexamethasone prophylacticly given immediately after ablation to interim atrioventricular block patients can effectively prevent delayed block.(2) Historical and electric damage can be enlarged after ablation,hence appearing delayed block.Delayed block has beneficial or bad effects,so electrophysiological phenomena producing delayed block should carefully observed during ablation.