冷盐水灌注导管对常规射频消融失败心房扑动患者的消融治疗

Successful Ablation of Common Atrial Flutter With Cool-tipped Catheter in Patients After Failuer of Conventional Radiofrequency Ablation.

常规射频消融在部分普通型心房扑动患者不能产生三尖瓣环至下腔静脉之间峡部的双向传导阻滞 ,本研究观察冷盐水灌注导管对该部分患者的消融效果。 12 5例行射频消融治疗的普通型心房扑动患者中 ,7例患者从三尖瓣环至下腔静脉口或至欧氏嵴射频消融超过 15次未能产生峡部双向传导阻滞 ,定义为射频消融失败。对该 7例患者换用冷盐水灌注导管 ,以相同于常规射频消融的方法在峡部找到传导间隙后 ,行射频消融。全部患者消融成功 ,平均消融 4.5± 2次 ,导管温度 40± 1℃ ,阻抗 79± 5 .4Ω ,未观察到明显的并发症。表明常规射频消融的失败与常规射频消融不能产生峡部足够的损伤有关 ,冷盐水灌注导管对常规射频消融失败的患者可以成功地产生峡部的双向传导阻滞。

To investigate the role of cool tipped saline irrigated catheter in the cure of common atrial flutter (AFL) refractory to conventional radiofrequency (RF) ablation.Of 125 patients with common atrial flutter whose post pacing interval equaled to flutter cycle length,bidirectional block in cavotricupid isthmus was failed in seven cases(male 5,female 2,aged 54±12 years)after 15 deliveries of RF energy application using conventional aproach.The cool tipped saline irrigated catheter was applied to those patients thereafter,the conducting gap in isthmus was found in the same way as the conventional approach,and ablated.The result showed that all the patients were successfully ablated.The mean RF energy application was 4.5±2 times with the mean temperature 40±1 ℃.No obvious complication was found.It seemed that the failure of conventional RF ablation was due to the inadequate injury to the isthmus,and such kind of AFL could be successfully ablated with the cool tipped saline irrigated catheter.