间隔区域消融延迟出现的房室阻滞

Late occurrence of heart block after radiofrequency catheter ablation of the posteroseptal region

目的慢径消融或后间隔旁路消融延迟出现的房室阻滞并发症少见。本文报告4例射频消融后出现的房室阻滞及其预后。方法519例房室结折返性心动过速行下位法消融慢径,98例行右后间隔旁路消融,共有4例延迟(>24h)出现房室阻滞。结果慢径消融组的3例患者分别于术后2、3d出现二度Ⅰ型房室阻滞并于术后2、4、9d消失。后间隔旁路消融组有1例患者于术后2d出现二度Ⅰ型房室阻滞,并于术后13d消失。射频消融放电15～31(25.6±8.7)次,能量20～50(29.0±19.2)W。放电过程中无快速的交界区心动过速或者>1个无逆传的连续交界区心律。4例患者在射频消融前后房室结前向和逆向传导功能均正常。结论慢径和后间隔旁路消融延迟出现的房室阻滞非常少见,通常在1～2周内恢复。

Objective To investigate the late occurrence of heart block at least 24 hours after radiofrequency catheter ablation(RFCA)of atrioventricular nodal reentrant tachycardia(AVNRT) or posteroseptal accessory pathway (AP). Methods Three of 519 patients with AVNRT undergoing RFCA using a posterior approach and 1 case of 98 patients with posteroseptal AP undergoing RFCA developed late heart block. Results Three patients with AVNRT developed Mobitz type I block at 2,2,3 days after RFCA which disappeared at 2,4,9 days after the procedure respectively.One patients with accessory pathway developed Mobitz type I block at the day 2 after RFCA which disappeared at the day 13.Anterograde and retrograde AV nodal conduction before and after RFCA were normal in all of the 4 cases.Patients received 15～31(25.6±8.7)RFCA lesions,with mean power of 20～50(29.0±19.2)W.No rapid junctional tachycardia or >1 consecutive retrograde block complex was observed during RFCA. Conclusion Late unexpected heart block after RFCA of AVNRT and posteroseptal AP is rare and often resolves uneventfully in 1 to 2 weeks.