射频消融术后出现延迟性房室阻滞五例

报道5例射频消融后出现的房室阻滞及其临床转归和电生理特点。1219例房室结折返性心动过速行下位法消融慢径,208例右后间隔旁道参与的心动过速行右后间隔消融,共有5例出现延迟后(>24h)的房室阻滞。慢径消融组的患者3例分别于术后第2,3,5天出现Ⅱ度Ⅰ型房室阻滞,并于术后第4,9和14天消失。后间隔旁道消融的2例患者于第2天出现Ⅱ度Ⅰ型房室阻滞,并分别于第11,13天消失。射频消融放电20.6±8.7(11～31)次,能量30±17.2(20～50)W。放电过程中无快速的交界区心动过速或者>1个无逆传的连续交界区心律。5例在射频消融前后房室结前向和逆向传导功能均正常。结论:慢径和后间隔旁道消融均可出现延迟性房室阻滞,通常能在1～2周内恢复。

Late Occurrence of Atrioventricular Block After Radiofrequency Catheter Ablation of the Posteroseptal Region

The objective of this study is to investigate the late occurrence of atrioventricular block in AV nodel reentry or posteroseptal accessory pathway AP patients after radiofrequency catheter ablation(RFCA),the clinical outcome,and findings in electrophysiologic study.Three of 1 219 patients with AV nodal reentry undergoing RFCA using a posteroir approach and 2 of 208 patients with RFCA of a posteroseptal APs developed late atrioventricular block ECG-documented Mobitz type I block in three patients was obtained at 2,3 and 5 days and disappeared at 4,9 and 14 days after RFCA espectively.Two patients with accessory pathways developed Mobitz type I block at second day after RFCA and that disappeared at 11 and 13 days.Anterograde and retrograde AV nodal conduction before and after RFCA were normal in five patients.Patients received 11-13 RFCA lesions,by using a mean maximum power of 30±17.2(20-50) W.No rapid juctional tachycardia or 1 consecutive retrograde block complex was observed during RFCA.Conclusion:Delayed atrioventricular block which usually recovers in 1 to 2 weeks after RFCA of AV nodal reentry and posteroseptal AP is rare.