射频导管消融治疗快速性心律失常

TREATMENT OF TACHYARRHYMIAS BY RADIOFRE QUENCY CURRENT CATHETER ABLATION

对１０５例快速性心律失常患者进行射频导管消融治疗，结果１０３例获成功，成功率９８．１％。房室折返性心动过速（ＡＶＲＴ）消融成功靶点：显性旁路ＡＶ≤４０ｍｓ，Ａ／Ｖ＜１，Ｖ波较体表心电图最早ｄｅｌｔａ波提前≥２０ｍｓ，占８６％；隐匿性旁路在ＡＶＲＴ或右室起搏时ＶＡ≤４０ｍｓ，Ａ／Ｖ＜１，占８５％。旁室结折返性心动过速（ＡＶＮＲＴ）采用下位或后位法改良慢径，放电过程中均出现交界性心律并逐渐减少。特发性室速（ＩＶＴ）起源点均标到较体表心电图ＱＲＳ波提前２５～４５ｍｓ的高频低振幅电位。

tachyarrhymias cases were treated by radiofrequency current catheter ablation (RFCA).103 cases were successfully ablated,achieving a successful rate of 98.1%.The charaeteristics of AVRT at the ablation target site of the dominant accessory pathways(APs) were short AV intervals ≤40 ms,long V delta intervals ≥20 ms and A/V ratio <1(86%).When recessive APs were ablated during ventricular pacing or induced AVRT,the VA intervals were short ≤40 ms and A/V ratio<1(85%).The slow pathway ablation in AVNRT was achieved by the inferior approach.The decrease in the number of junctional rhythm during energy application is a good sign for predicting successful modification of the atrioventricular node.The successful ablation sites of IVT were characterized by an endocardial activation time of 25￣45 ms,earlier than the onset of QRS during tachycardia.And the earliest activation was preceded by an abnormal high frequency potential with low amplitude.