慢径消融或改良治疗房室交界区折返性心动过速远期疗效的评价

The long term results of catheter radiofrequncy ablation or modification of slow pathway for the treatment of atrioventricular junctional reentrant tachycardia

目的 评价慢径消融或慢径改良对房室交界区折返性心动过速 (atrioventricularjunctionalreentranttachycardia ,AVJRT)远期复发的影响。方法 2 31例AVJRT患者进行常规慢径消融 ,比较慢径消融 (慢径消失 )或改良 (慢径存在 )者AVJRT的复发率和并发症以及各组消融前后的电生理参数变化。结果 射频消融后 142例慢径残存 ,5 3例慢径消失 ,房室结有效不应期延长 ,1∶1房室和室房传导的最大频率减慢。 36例消融前后均无AH间期跳跃现象。术后 (2 5± 4)个月的随访期内 ,慢径消融的 89例中复发 1例 ,4例发生二度Ⅰ型房室阻滞。慢径改良的 142例复发 2例 ,复发率无差别 (P >0 0 5 )。结论 慢径消融或改良治疗AVJRT可以达到同样疗效。

Objective To evaluate the long term results of catheter radiofrequency (RF) ablation or modification of the slow pathway for the treatment of atrioventricular junctional reentrant tachycardia (AVJRT). Methods Standard electrophysiological parameters and comparable antegrade AV node function curves were obtained in 231 patients before and after catheter ablation of common form AVJRT. Both the complications and recurrent rate were compared in these two groups. Results Slow pathway conduction remained in 142 cases and abolished in 53 cases after successful catheter ablation. The effective refractory period of AV node prolonged and the maximum rate of one to one AV or VA conduction slowered in both group. Thirty-six cases had smooth AV node function curves before and after catheter ablation. During a mean follow-up of (17±4) months, clinical AVJRT recurred in 1 of 53 patients who had disappearance of AV node duality after catheter ablation, in 1 of 26 patients who did not show AV node duality before and after ablation, and in 1 of 142 patients who had persistence of AV node duality after ablation. Conclusion For the purpose of the treatment of AVJRT, catheter RF ablation and modification are equally effective. The disappearance of AV node duality is not crucial.