冷冻消融慢径治疗房室结折返性心动过速临床研究

Transcatheter cryoablation of slow pathway for the atrioventricular nodal reentrant tachycardia

目的探讨冷冻消融慢径治疗房室结折返性心动过速（AVNRT）时有效靶点的分布和冷冻消融的特点。方法选取53例AVNRT患者，常规行心内电生理程序刺激检查及冷冻标测，确定有效靶点后进一步行冷冻消融治疗。结果所有患者冷冻消融治疗均获成功。冷冻消融慢径成功的有效靶点位于希氏束与冠状窦口之间的前区（A区）8例（15．1％），位于中区（M区）39例（73．6％），位于后区（P区）6例（11.3％）；其中2例患者在有效靶点行冷冻消融时出现Ⅰ度房室传导阻滞、AH延长，立即停止冷冻，复温后传导即恢复正常；冷冻消融治疗前后快径前传导有效不应期、AH快径最大值均无明显差异（P〉0．05）。结论房室结折返性心动过速行慢径冷冻消融的有效靶点绝大多数分布位于M区，少数分布于A、P区，在特殊的邻近希氏束部位的A区行冷冻消融是安全、可行的，具备独特的优势。

Objective To investigate the distribution of the target sites of successful cryoablation of slow pathway for the atrioventricular nodal reentrant tachycardia （AVNRT）. Methods Intracardiac electrophysiology examination and cryomapping were performed in 53 patients with atrioventrieular nodal reentrant tachycardia, and then the cryoablation were followed. Results The effective target sites of successful cryoablation of slow pathway were located at the anterior area （area A） between the His bundle and the coronary sinus ostium in 8 cases （15.1%）, at medial area （area M） in 39 cases （73.6%）, and posterior area （area P） in 6 cases （11.3%）. At the effective target sites of cryomapping, the transient AV prolongation occurred during cryoablation in 2 oases, the normal atrio-ventricular conduction was restored immediately after the cryoablation was stopped. There were no significant differences in effective refractory period-fast pathway （ERP-FP） and AH-FPmax before and after cryoablation. Conclusion The most frequent sites of suceessfut eryoabtation of slow pathway for AVNRT are area M, followed by area A and P; the transcatheter cryoablation at area A adjacent to the His bundle region is safe and feasible with unique advantages.