冷冻消融慢径治疗房室结折返性心动过速的初步临床应用

Clinical Application of Transcatheter Cryoablation of Slow-Pathway for Treatment of Atrioventricular Nodal Reentrant Tachycardia

为探讨冷冻消融治疗房室结折返性心动过速(AVNRT)的疗效、安全性及其方法。对13例AVNRT行冷冻消融慢径,用-30℃冷冻粘附后行冷冻标测,确定有效靶点且无快径损伤后,立即进行-75℃冷冻消融,消融240～300s,消融过程中密切观察房室结传导功能,一旦发现有房室结损伤,立即终止消融,改换靶点。结果:13例,均获成功,随访1～9个月,无复发;在-30℃冷冻标测时,冷冻消融导管头端与靶点冷冻粘附,无位移现象;冷冻消融过程中无结性早搏或结性心律出现;1例在冷冻标测,另1例在冷冻消融过程中出现一过性房室阻滞,立即停止冷冻后复温,即刻传导恢复。无其它并发症发生。结论:冷冻消融是治疗AVNRT的有效方法,并能降低永久性房室阻滞的风险。

To investigate the efficacy, safety and methods of transcatheter cryoablation of atrioventricular nodal reentrant tachycardia （ AVNRT）, thirteen patients underwent transcatheter cryoablation of AVNRT and the slow pathway was targeted in each patient. Cryomapping was performed after cryoadheres to the target point at a temperature of -30℃ and cryoablation was performed at a temperature of -75℃ for 240～300 seconds after confirming the target point and no fast-pathway injury. During the cryoablation, the atrioventricular nodal conduction was guarded. When the injury of atrioventricular node was found, the cryoablation stopped and the target point changed. Results ： In thirteen patients cryoablation succeed and had no relapse for 1 to 9 months. There was no migration of the joint between the target point and top of cryoablation catheter at temperature of - 30℃. During the cryoablation, no nodal premature beat and nodal rhythms were found. Two case developed complete AV block during cryomapping and cryoablation and disappeared within 8 seconds after rewarming. Other complications didn＇t happen. Conclusion： Cryoablation is an effective therapy for AVNRT. Cryomapping helps to identify the optimal ablation site, thus minimizes the risk of peawnanent AV conduction.