局部单极电图在房室结折返性心动过速射频消融术中的应用

Application of unipolar cardiac electrogram in radiofrequency ablation for atrioventricular nodal reentrant tachycardia

目的探讨在特殊情况下，单极电图能否代替双极电图运用于房室结折返性心动过速射频消融术中弥补体表心电图中的不足。方法将冠状窦、希氏束及大头消融电极与胸导联相连，记录局部单极电图，运用于５例病人，观察心动过速、射频消融过程中心房波、心室波的关系，并与２０例房室结折返性心动过速病人双极记录的特征相比较。结果（１）心动过速均显示出逆Ａ呈向心性分布的特征（１００％ｖｓ１００％，Ｐ＞０．０５）；（２）消融过程中单极电图可清楚显示交界心律时的传导情况（１００％ｖｓ１００％，Ｐ＞０．０５）。结论在特殊情况下，使用局部单极电图可代替双极记录，弥补体表心电图在诊断房室结双径路以及射频消融术中的不足，避免完全性房室传导阻滞的发生。

Objective To demonstrate the usefulness of unipolar cardiac electrogram in radiofrequency (RF) ablation for atrioventricular nodal reentrant tachycardia (AVNRT) MethodsZUnipolar Cardiac electrogram could be acquired in 5 patients with AVNRT by connecting lead V16 of the surface ECG with mapping catheters in coronary sinus,His bundle,and target site Results Compared to method of bipolar cardiac electrogram obtained from 20 patients with AVNRT in modification of AV node by RF current,unipolar method showed the characteristics of AVNRT clearly (100% vs 100%,P>005) and the anteriorgrade and retrograde conduction of junctional rhythm during energy delivery (100% vs 100%,P>005)No case suffered atrioventricular block Conclusion Unipolar method can be used in the RF ablation for the AVNRT safelyUnder special circumstances that bipoplar method is not available,it can be selected to guide ablation procedure