病态窦房结综合征合并阵发性心房颤动的射频消融治疗

目的探讨病态窦房结综合征患者合并阵发性房颤的射频消融治疗效果。方法 7例病态窦房结综合征合并阵发性房颤患者,术前动态心电图诊断为病态窦房结综合征,24小时内有数次停搏及多次阵发房颤发作,其中有5例患者停搏均发生在房颤终止时,2例停搏与房颤发作无明显关联。接受环肺静脉前庭电隔离术。术后动态心电图随访。结果该7例患者,有2例房颤复发,1例再次接受手术并成功,1例拒绝再次手术。动态心电图提示有4例(考虑为快慢综合征)心动过缓明显好转,2例(考虑为慢快综合征)房颤发作明显减少但是心动过缓无改善,接受心脏永久起搏器置入治疗。此7例患者术前与术后1个月最大心率、最小心率、平均心率比较,最小心率、平均心率术后较术前增加,最大心率术后较术前无明显变化。结论快慢型病态窦房结综合征合并阵发性房颤患者对房颤射频消融治疗效果较好,大部分患者术后心动过缓明显改善,而不需要置入心脏永久起搏器。

Treatment of patient with Sick sinus syndrome and paroxysmal atrial fibrillation by radiofrequency ablation

Objective To investigate effect radiofrequency ablation in patient with Sick sinus syndrome and paroxysmal atrial fibrillation.Methods Seven patients with sick sinus syndrome and paroxysmal atrial fibrillation were included.Sick sinus syndrome was diagnosed by Holter and found several pauses and atrial fibrillation episodes in 24 hours.The pauses occurred in the termination of atrial fibrillation in 5 patients.All patients performed circumferential pulmonary vein isolation ablation with Holter follow-up.Results Among the 7 patients,2 patients and atrial fibrillation recurrence and 1 patient underwent successful re-ablation but the other refused reoperation.Four patients showed improvement in bradycardia.Atrial fibrillation was significantly reduced in 2 patients but their bradycardia was not controlled and reguired permanent pacemaker implantation.The maximum heart rate,minimum heart rate and mean heart rate showed no statistical difference before and 1 month after operation.Conclusions Radiofrequency ablation showed satisfactory control of bradicardia in patients with sick sinus syndrome and paroxymal atrial fibrillation without the need for permanent pacemaker implantation.