心脏病伴室上性心动过速射频消融和手术治疗的对比研究

RADIOFREQUENCY CATHETER ABLATION AND SURGICAL TREATMENT OF SUPRAVENTRICULAR TACHYCARDIA IN PATIENTS WITH STRUCTURAL HEART DISEASES

目的 :比较心脏病伴阵发性室上性心动过速 (PSVT)射频消融或手术切割的疗效及各自的特殊性。方法 :对 2 4例心脏病伴房室折返性或房室结折返性心动过速患者进行了射频消融或外科旁路切割术。结果 :10例射频消融的首次成功率为 90 % ,无严重并发症。 14例手术患者心外膜标测检出 17条旁路 ,手术成功率为 94 %。 1例术后复发 ,射频消融成功。 1例围术期死于呼吸衰竭 ,1例遗留永久性Ⅰ度房室传导阻滞 ,余 12例无与旁路切割相关的并发症。结论 :心脏病伴PSVT的射频消融或手术治疗均有较高的成功率 ,并发症少。心脏病需手术治疗的患者合并房室旁路时 ,应首选外科旁路切割术 ,可同时治愈两种疾病。

Objective:To evaluate the effect and particularity between the radiofrequency catheter ablation (RFCA)and the surgical treatment of paroxysmal supraventicular tachycardia(PSVT)in patients with structural heart diseases.Methods:RFCA was performed in 10 patients with organic heart disease and associated atrioventricular or atrioventricular nodal reentrant tachycardia.Surgical intervention was given in 14 patients with congenital or valvular heart diseases and associated atrioventricular reentrant tachycardia.Results:The first RFCA success rate was 90%(9/10)without significant complications.94% were successfully treated by surgical dissection.One patient had recurrence of PSVT in one month after the surgery and was successfully ablated by RFCA.One patient died of respiratory failure.The first degree atrioventicular block was found in one patient postoperatively.Conclusion:PSVT in patients with structural heart diseases could be successfully treated by both RFCA and surgical operation.Surgical management of atrioventricular reentrant tachycardia should be considered in patients with congenital or valvular heart diseases because it could not only correct the structural heart diseases but also abolish the associated PSVT.The patients who failed of the surgical operation could be also successfully treated by RFCA.