摘要
【目的】探讨房室结慢径路消融有效放电过程心电监测的意义。【方法】 5 8例慢 快型房室结折返性心动过速在有效靶点以低射频能量 (15～ 2 5W )放电 ,监测心电变化 ,出现 :①交界区心律 >15 0min-1,②交界区心搏伴室房阻滞 ,③窦性心搏P R间期延长 ,视为房室传导阻滞的先兆 ,即刻终止放电 ,否则持续放电至交界区心搏逐渐减少或消失 ;若交界区心搏无减少 ,则持续放电至 90～ 12 0s。【结果】 5 8例房室结慢径路消融均获成功 ,有效放电过程均出现交界区心搏 ,放电时间 (12 8±2 6 )s,5 4例 1次消融成功 ,4例需 2次消融。 6例出现一过性房室传导阻滞 ,其中 4例于交界区心搏伴室房阻滞即刻停电后发生 ,2例于窦性心搏P R间期延长即刻停止放电后发生 ,无 1例出现永久性房室传导阻滞。随访 (18± 16 )月 ,2例复发 ,再经消融后未再复发。【结论】心电监测可指导射频能量的应用 ,从而提高房室结慢径路消融成功率 ,减少复发 ,避免永久性房室传导阻滞发生。
Objective To explore the significance of electrocardiogram monitoring during the effective application of radiofrequency energy to slow atrioventricular (AV) nodal pathway ablation. Methods Slow AV nodal pathway ablation was performed in 58 patients with slownfast AV nodal ree-trant tachycardia (AVNRT). The changes of electrocardiogram were monitored during the effective application of low radiofrequency RF energy (15～25 W). A faster rate of junctional ectopy (>150 min -1 ), ventriculoatrial (VA) block in association with junctional ectopy, and long P-R interval during sinus beat were considered as harbingers of atrioventricular (AV) block. RF energy deliveries were discontinued as soon as the harbingers of AV block occurred. Otherwise, RF energy continued until junctional ectopies were decreased or vanished. If junctionnal ectopies were not decreased, RF energy continued lasted for 90～120 s. Results Slow AV nodal pathway ablation was successful in all patients who had junctional ectopy during the effective delivery of RF energy. The effective ablation time was (128±26) s. 54 patients experienced one time successful ablation, and 4 patients experienced two times ablation. Unsustained AV block occurred in 6 patinets after RF energy deliveries which were immediately terminated because of VA block in association with junctional ectopy in 4 patinets and long P-R interval during sinus beats in 2 patients. No patients developed permanent AV block. Recurrent AVNRT requiring second ablation occurred in 2 of 58 successfully ablated slow pathway during (18±16) months of follow-up. Conclusion RF energy deliveries could be instructed by intracardiac electrocardiogram monitoring during AVNRT ablation, which could enhance the successful rate of slow pathway ablation, reduce recurrence and avoide permanent AV block.
出处
《中山医科大学学报》
CSCD
北大核心
2001年第1期54-56,共3页
Academic Journal of Sun Yat-sen University of Medical Sciences
