房性心动过速的导管射频消融术治疗

Retrospective study on clinical treatment of atrial tachycardia by radiofrequency catheter ablation

目的:探讨房性心动过速(房速)行导管射频消融术(RFCA)治疗方法、疗效及其安全性。方法:选择24例经心内电生理检查证实为房速并同意行RFCA治疗患者,常规电生理检查分别在高位右房(HRA)、右室心尖部(RVA)2个部位行S1S1刺激和程控期前收缩刺激,记录房速的诱发和终止方式。靶点标测采用激动标测法,单根消融导管于右房或左房(经房间隔穿刺)内标测寻找最早心房激动或用多极导管作为参考电极,再用大头导管寻找消融靶点。根据消融结果,分析房速的起源部位、消融即时成功率、并发症、复发原因以及X线曝光时间等。结果:24例房速患者中,22例(88%)右房房速,3例(12%)左房房速(1例患者同时存在左、右房2个部位房速)。4例与其他心律失常合并存在,1例房室结折返性心动过速,1例合并房性折返性心动过速,1例合并心房颤动,1例同时合并心房扑动和心房颤动。24例患者均完成射频消融治疗(实际消融25例次),均采用温控消融,按预定消融终点,23例次即时消融成功,即时成功率92%(23/25),平均X线曝光时间(32±6.4)min,消融失败2个病例中,右房房速和左房房速各1例,再次消融成功。未发生房室传导阻滞、心包填塞等严重并发症。结论:RFCA是治疗房速安全、有效的方法,结合多极参考电极和三维标测系统,能更准确的定位复杂病例房速起源和判断机制,从而提高成功率。

Objective：To investigate the methods,efficacy and safety of clinical treatment of atrial tachycardia（AT） by radiofrequency catheter ablation（RFCA）,and to make prospect on the new therapic way.Method：Intracardiac electrophysiologic study（EPS） and RFCA were performed in consecutive 24 patients with AT.The induc-tive and terminative condition were recorded.Mapping techniques were based on identification of the earliest endocardial atrial electrogram recorded during AT with one large-tipped catheter or multipolar catheter as the reference electrode in the right or left atrium,then performed ablation.The location of AT,the efficacy and safety and complication of RFCA,the cause of recurrence,fluoroscopic time were retrospective analyzed after ablation.Result：Among the 24 patients,there were 22（88%） cases of right AT and 3（12%） cases of left AT（1 patient was right AT associated with left AT）.There were 1 case associated with atrioventricular nodal reentrant tachycardia（AVNRT）,1 case associated with atrioventricular reentrant tachycardia（AVRT）,1 case associated with atrial fibrillation,1 case associated with atrial fibrillation and atrial flutter.All 25 AT cases were performed RFCA completely under temperature control ablation,average fluoroscopic time was（32±6.4） min,there were 23（92%） successful case in first session.1 right AT and 1 left AT in the 2 recurrence cases,can be cured in second RFCA.No serious complication such as complete atrioventricular block（AVB）,pericardial tamponade and pulmonary embolism happened.Conclusion：RFCA was a efficacy and safety of clinical treatment of AT,more achievement ratio could be got in complicated cases through multipolar reference electrode and three diamensions mapping system.Primary electrophysiological excited sequence mapping could guarantee higher achievement ratio and lower recurrence ratio RFCA of right AT under more shorter fluoroscopic time.Successful ablation target suggested that right AT was more than left AT,and the mainly foci were located coronary sinus ostium and crista terminalis.AT located in left atrium or some special sites,and the target mapping unsatisfiedly were associated with noneffective ablation and recurrence.