室上性心动过速特殊病例的射频消融结果评价

Evaluation of the results of radiofrequency catheter ablation in special patients with supraventricular tachycadias

目的研究室上性心动过速(SVT)合并风心病、冠心痛及电生理检查(EPS)不能诱发心动过速等特殊病例行EPS及导管射频消融(RFCA)治疗的有效性及安全性。方法共26例,男12 例,女14例,年龄21-76岁;SVT合并风心病5例(心功能Ⅱ-Ⅲ级),合并冠心病7例,EPS心动过速不能诱发14例(其中11例存在房室结双径路);常规行EPS及RFCA,合并单纯二尖瓣狭窄者(2 例)同时行经皮二尖瓣球囊扩张术(PBMV),合并冠心病冠脉造影病变较重者(2例)择期行经皮冠脉内干预治疗(PCI),SVT不能诱发但有房室结双径路(DAVNP)证据者行经验性房室结改良术(AVNM)或放弃RFCA。结果5例SVT合并风心病患者RFCA均成功,其中2例同时行PBMV也均成功(瓣口面积分别由术前1.04与1.16扩大至2.30与2.42cm2),随访1例心动过速复发,再次RFCA成功,心功能持续改善;7例SVT合并冠心病RFCA也均成功,其中2例术后1个月与3个月成功施行PCI术,随访无心动过速复发,冠心病症状无或轻微;6例经验性AVNM均成功阻断慢径传导,随访无一例心动过速复发,另5例未予干预患者中4例心动过速复发。所有病例均无重要手术相关并发症发生。结论SVT合并风心病、冠心病患者在术前相应药物治疗下能够耐受EPS及RFCA 过程,其有效性及安全性与无器质性心脏病并存者类同,适应证病例可同时或择期行PBMV或PCI 治疗;经典AVNM术可使EPS不能诱发心动过速的DAVNP患者获根治目的。

Objective To study the efficacy and safety of radiofrequency catheter ablation(RFCA) in patients with supraventricular tachycardia(STV) combining with organic heart diseases and dual at-rial ventricular node pathway(DAVNP) to be not induced to atrial ventricular node reentry tachycardia (AVNRT) by electrocardiophysiology study(EPS). Methods 26 patients aged 21-76yr. ,including 5 cases of SVT combining with rheumatic heart disease (RHD), 7 cases with coronary artery disease (CAD) and 14 cases without SVT by EPS (among them 11 cases with the evidences of DAVNP). RF-CA and percutaneous balloon mitral valveloplasty (PBMV) or percutaneous coronary intervention (PCI) would be performed simultaneously or selective time after RFCA in the cases of SVT combining with RHD or CAD. For the cases of DAVNP being not induced SVT, atrioventricular nodal modification (AVNM) being tried or not intervented. Results 12 cases of SVT combining with RHD or CAD successfully and safely underwent the procedures of EPS and RFCA, among them the PBMV (2 cases) or PCI (2 cases) were completed simultaneously or within 3 months after RFCA, SVT recurred in only one case during follow-up. The procedures of AVNM were successfully completed in 6 cases of DAVNP without SVT by EPS, and no one being recurrent SVT by follow-up, in 4 patients among cases of being not intervented, however, SVT were occurred. Conclusion EPS and RFCA are effective and safe measures for the cases of SVT combining with RHD or CAD, with similar successful rate and complications to general SVT cases, AVNM can be effectively used in the cases of DAVNP bing not induced to SVT by EPS.