射频消融房室旁路及房室结慢径路治疗阵发性室上性心动过速的临床应用

Clinical Application of RFCA for AVRT and AVNRT

本组46例，男25例，女21例，年龄44．3±12．8岁，均为反复发作室上性心动过速，药物难以长期控制者，其中5例预激合并房颤旁路前传。体检及辅助检查：正常心脏38例，冠心病4例，高血压3例，先天性二叶式主动脉瓣1例。除5例预激合并房颤者，术前口服胺磺酮600mg／d，7～10d，余41例均停用抗心律失常药物5个半衰期以上。消融靶点为最短的A-V（显性旁路）或V-A（隐匿性旁路）间期，或记录到旁路电位的部位。房室结改良均采用下位法消融慢径。旁路31条，29条旁路被阻断，成功率为93．5％，其中左侧成功率为96％，右侧成功率为83．3％。15例双径路改良法，14例成功消融慢径（93．3％），1例误消融快径出现Ⅰ度房室传导阻滞。随访45例（平均15±6个月），1例有心动过速复发，其余均无室上性心动过速或房颤复发，效果显著。

46 patients with tachyarrhythmias were treated by radiofrequency catheter ablation(RF-CA). There were 25 males and 21 females (mean age 44. 3± 12. 8 years). Their conditionswere refractory or intolerable to antiarrhythmic drugs. Five patients had history of atrial fib-rillation accompanying with anterograde accessory pathway conduction. Eight patients associ-ated with cardiovascular disorders. There were 31 patients with 31 APs (19 left free wall, 3left posterolateral, 3 left posteroseptal, 4 right free wall and 2 right posteroseptal). 29 APswere abolished permanently. Total success rate was 93. 5 % (left AP 96%,right AP 83. 3% ).In 15 patients with AVNRT underwent AVN modifications, 14 of them(93. 3% ) were selec-tive ablation of slow pathways without injury of fast pathways. One case happened to ablatefast pathway,and one degree AVB occurred. During follow -up period of 15 ± 6months,Onepatient with AVRT recurred but tachyarrhythmia of the others did not and one patient withone degree AVB developed to two degree AVB.