射频消融和DDD起搏器治疗典型心房扑动伴缓慢心室率五例

目的探讨典型心房扑动(简称房扑)伴缓慢心室率的介入治疗。方法5例房扑伴缓慢心室率患者,房扑频率240～260次/分,房室传导比例5:1～6:1。1例患者已置入VVI起搏器,但仍有症状。对房扑采用解剖学影像定位法消融下腔静脉与三尖瓣环的峡部。对缓慢心室率采取DDD起搏器治疗(1例VVI改换DDD)。结果消融中房扑终止,峡部达双相阻滞,房扑终止后1例为Ⅱ度Ⅱ型房室传导阻滞,4例为Ⅲ度房室传导阻滞。均成功置入DDD起搏器。随访7～37个月,房扑未见复发,起搏器工作良好,患者症状消失。结论射频消融和DDD起搏器联合治疗典型房扑伴缓慢心室率患者有效而且安全。

Radiofrequency cather alation and DDD cardiac pacemaker implantation in 5 patients with slow ventricular rate of atrial flutter

Objective To investigate the cardiac interventional procedures of typical artrial flutter（AFL） with slow ventricular rate. Methods Five patients with slow ventricular rate of AFL were entrolled in the study. Who had 240 - 260 beats/min AFL rate and 5：1 -6：1 atrioventricular（AV） conduction. One patient who had implanted VVI cardiac pacemaker still had symptoms . Radiofrequency alation was performed from the tricuspid annulus to the eustachican ridge of AFL and DDD cardiac pacemaker was performed on patients with slow ventricular rate （ one patient was replaced VVI for DDD pacemaker）. Results AFL was terminated during radiofrequency alation and the complete bidiretional isthmus block was achived. After radiofrequency alation ,one patient developed two degree two type AV block and four patients developed tree degree AV block. DDD cardiac pacemaker implantation was successfully performed in all patients. No AFL and symptoms recurred in patients during 7 - 37 months follow-up with pacemaker working well. Conclusion Radiofrequency cather alation and DDD cardiac pacemaker are safe and effective procedures in treatment of AFL with slow ventricular rate.