两种不同机制心动过速并存的射频消融治疗

目的：观察两种不同机制心动过速并存的心内电生理特点射频消融的疗效。方法：８例患经全面的心内电生理检查，确定存在两种不同机制的心动过速，常规消融一种心动过速后，重复电生理检查，诱发第２种心动过速；，再次消融治疗。结果：房室结折性心动过速；＋房室折返性心动过速３例，ＡＶＮＲＴ＋房内折返性心动过速３例，ＡＶＮＲＴ＋室性心动过速１例，ＡＶＲＴ＋ＩＡＲＴ１例。

Radiofrequency catheter ablation for treatment of two types of tachycardia with different mechanisms

Objective: To observe the properties of intracardiac electrophysiologic study(EPS) and the efficacy of radiofrequency catheter ablation(RFCA) in patients with 2 types of tachycardia of different mechanisms. Methods: The study included 8 patients (4 men, 4 women) with 2 types of tachycardia of different mechanisms confirmed by complete EPS. After ablation of one tachycardia, complete EPS was repeated to induce the second tachycardia, then ablated it again. Results: In this group atrioventricular nodal reentry tachycardia (AVNRT) + atrioventricular reentry tachycardia (AVRT) was found in 3 patients, AVNRT + intraatrial reentry tachycardia (IART) in 3, AVNRT + ventricular tachycardia (VT) in 1 and AVRT + IART in 1. We found AH jumps > 50 ms in 6 of 7 patients with AVNRT which disappeared after successful ablation. All of 4 IART were originated in right atria. Electrophysiologic studies before ablation only showed 3 patients who had 2 types of tachycardia, in other 5 patients another tachycardia was confirmed when repeated EPS after the ablation of the first tachycardia. A syncopic patient with VT and AVNRT, the successful ablation site of VT was located in right low ventricular septum near apex. Except for one IART, all tachycardia were ablated successfully with a mean of (233) min of Xray without adverse effects. During the followup of 531 months, all patients remained free from tachycardia. Conclusion: Though coexistence of 2 types of tachycardia with different mechanisms makes operation complicated, accurate diagnosis could be made as long as electrophysiologic studies are done completely and catheter ablation is also an effective and safe treatment.