经食道心房快速起搏终止心房扑动的方法学及效果评价

Method and efficiency of transesophageal atrial overpacing to terminate atrial flutter

目的对32例心房扑动（房扑）发作患者采用经食道心房快速起搏方法进行终止，对其方法及疗效进行评价。方法经鼻插入食道电极，深度至食道电图能记录到最大心房电位处。使用20～35V输出电压、10ms脉宽进行心房S1S1250—600次／min逐级递增快速起搏，每次递增50次／min，每次起搏时间2～5s，至房扑终止。结果32例患者共36次房扑，其中32次经食道心房快速起搏终止，转复成功率89％，典型房扑成功率100％（27／27次），非典型房扑成功率56％（5／9次）。平均操作时间（38±15）min，7次（22％）直接转为窦性心律，25次（78％）先经历房颤然后转为窦性心律。术中快速起搏时多数患者出现不同程度的胸骨后烧灼感，均能良好耐受，无血栓栓塞及其他不良反应发生。结论经食道心房快速起搏终止心房扑动是一种快速、安全、简便、有效的方法，可作为房扑转复的首选治疗。

Objective To evaluate the method and efficiency of episodes of atrial flutter treated by transesophageal atrial overpaeing. Method The catheter was inserted into esophagus through nose, where the greatest atrial potential could be recorded. The stimulation program of S1 was performed from 250 bpm to 600 bpm with output of 20 - 35 volt and 10 ms pulse width. Every times of stimulation lasted for 2 -5 seconds increasingly 50 bpm until termination. Results Thirty-two episodes of atrial flutter were successfully terminated by transesophageal atrial overpaeing. The total success rate of conversion was 89% （32/36）, the rate was 100% （27/27） in patients with typical atrial flutter and 56% （5/9） in that with atypical atrial flutter. The mean time of procedure was 38 ± 15 minutes. Seven （22%） episodes of atrial flutter were covered into sinus rhythm directly and 25 （78%） episodes conversion experienced the period of atrial fibillation. No patients felt uncomfortable except a bit of chest pain. No incidents such as embolism occurred. Conclusion The method of transesopha- geal atrial overpacing to terminate atrial flutter is safe, simple and convenient, and it can be used for the principal treatment in conversion of atrial flutter.