射频消融失败的房室折返性心动过速患者旁道的电生理定位及手术治疗

对１１例射频消融（ＲＦＣＡ）失败的房室折返性心动过速（ＡＶＲＴ）患者（８例合并有器质性心脏病）进行电生理定位及外科治疗。１０例心外膜标测定位结果与术前心内电生理定位一致。１１例旁道（ＡＰ）切割均获成功。１例死于围术期急性肾功能衰竭，２例分别于术后第２及３０日复发，再次ＲＦＣＡ成功。２例左后间隔显性ＡＰ遗留有ｄｅｌｔａ波。１０例随访１５．３±１２．８个月，无心动过速复发，合并的器质性心脏病均获治愈，心功能Ⅰ级。３例无器质性心脏病，２例为左后间隔ＡＰ，１例为右后游离壁ＡＰ，手术中证实ＲＦＣＡ失败系消融电极未能抵达有效靶点消融所致；２例Ｅｂｓｔｅｉｎｓ畸形合并房间隔缺损，１例为重度三尖瓣返流使消融电极不能稳定贴靠靶点，另１例为ＡＰ靠近心外膜面而致ＲＦＣＡ失败；１例风湿性心脏病联合瓣膜病因瓣膜及瓣下结构病理改变致ＲＦＣＡ失败；１例重度二尖瓣返流ＲＦＣＡ失败与病人不能耐受ＲＦＣＡ与ＡＰ定位于２４区消融导管难以抵达有关；先天性心脏病大房间隔缺损、重度主动脉关闭不全及矫正性大动脉转位右旋心伴三尖瓣返流各１例，ＲＦＣＡ失败与解剖畸形、心内大分流等血液动力学障碍有关。结果提示ＲＦＣＡ失败的ＡＶＲＴ在电生理标测指导下外科治疗?

Electrophysiologic Study and Surgical Treatment of Atrioventricular Reentrant Tachycardia in Patients Failed With Radiofrequency Ablation

Eleven patients with atrioventricular reentrant tachycardia(AVRT) who had failed from radiofrequency catheter ablation (RFCA) were treated by surgical operation.Eight patients had associated structural heart diseases.All patients had problematical preexcitation syndrome.Electrophysiological studies before operation in 11 patients and epicardial mapping during operation in 10 patients were performed and their localization showed no difference.All accessory pathways (AP) were successfully ablated and there were no intraoperative complications.One patient died of acute renal failure 5 days postoperatively.Two patients had recurrence of right lateral AP and were successfully treated by RFCA.In all,10 patients were cured after mean follow up 15.3±12.8 months.The causes of RFCA failure were demonstrated in surgical operation.In 3 patients without structural heart disease,ablation catheters were not located in distinct target sites during ablation of 2 left posteroseptal pathways and 1 right posterior wall pathway.In 2 cases of Ebsteins anomaly,ablations were failed by serious tricuspid regurgitation and AP at epicardium.In one case with rhumatic valvular disease,ablation catheter did not achieve mitral annulus because of pathologic changes.Other 4 cases with congenital heart disease were associated with anotomical anomaly and serious hemodynamic disturbance.The results indicated that AVRT in patients with structural heart disease or problematical preexcitation syndrome can be successfully treated by surgical operation with electrophysiological mapping.