摘要
导管射频消蚀术（ＲＦＣＡ）治疗房室结折返性心动过速４３例，采用＂中位法＂选择性阻断慢径路，该技术的关键是：①在Ｘ线右前斜位３０度下，将消蚀电极置于冠状窦口和希氏束连线的中点附近；②消蚀电极双极记录到小Ａ大Ｖ波；③放电时有交界性心律（包括快交界律、慢交界律、交界性早搏）；④以间断放电和时间递增的方法控制消蚀过程；⑤消蚀终点为放电总累积时间达６０～９０秒，重复电生理检查证实慢径阻断或心动过速不能诱发。经１～３个部位的消蚀彻底阻断慢道３６例，遗留慢径传导７例（有心房回波２例）。除１例术后第二天发生一过性Ⅲ°ＡＶＢ，二周恢复正常外，余无并发症发生，随访３～２４个月（平均１４±６），停用任何抗心律失常药，无心动过速发作。消蚀成功率１００％。认为“中位法”是消蚀房室结慢径路治疗房室结折返性心动过速的安全、简便和有效的方法，部分病例保留慢传导并不增加复发率。
Radiofrequency catheter ablation (RFCA) was performed in 43 patients with atrioventricular nodal reentrant tachycardia (AVNRT),using median approach for selective ablation of the slow atrioventricular nodal pathway. Key points of this technique are (1) under the RAO 30°of fluoroscopic projection, the catheter tip was located around the middle between His bundleand coronarysinus ostium; (2) a very small atrial and a big ventricular deflections can be recorded in bipolar by the ablation catheter;(3) junctional premature beats or rhythm can be noted during the delivery of radiofrequency current of 20 to 30 Walt;(4) the ablation time was controlled step by step in a incremental mede; (5) no inducible AVNRT was considered to be the end points after the total ablation time reached to more than 60 to 90 seconds,with or without the disappearance of slow pathway conduction.Through the ablation at 1-3target positions,the slow pathway conduction was disappeared in 36 patients,and existed in 7 patients(including atrial echoes in 2 patients). But all patients remained free from tachycardia during following-up of 3to 24 months, There is no complication except for one case of temporary complete atrioventricular block.The results suggested that the median approach is a safe、effective and simple method for treating AVNRT.
出处
《中国介入心脏病学杂志》
1996年第2期55-57,共3页
Chinese Journal of Interventional Cardiology
关键词
房室结双径路
心动过速
导管射频消蚀术
Catheter ablation Radiofrequency atrioventricular nodal Dualpathway reentrant Tachycardia
