房室结慢径消融电生理特性与临床疗效关系探讨

Relationship Between Electrophysiological Changes and Clinical Efficacy of Slow Atrioventricular Nodal Pathway Ablation

【目的】探讨房室结折返性心动过速 (AVNRT)慢径消融时心内电生理改变与临床疗效的关系。【方法】对 94例慢 快型AVNRT病人采用射频消融慢径治疗 ,分析消融前后电生理特征、消融时心内电生理改变和消融终点。【结果】 94例均消融成功 ,其中 75例 (80 % )慢径阻断 ,19例 (2 0 % )慢径未阻断 ,其中 2例 (2 % )慢径未阻断者并有 1～ 2个心房回波 ;术后随访 (2 8± 17)月 ,4例术后 1～ 5月复发 ,经再次消融成功。术中 5例消融时呈持续交界心律 ,经消融后仍然有心动过速发作 ,调整靶点后消融成功 ;4例放电时有房室传导阻滞先兆 ,用时间滴定法消融成功。【结论】慢径路消融的理想终点应该是电刺激诱发的心动过速消失 ;消融时出现持续交界心律是安全的 ,部分患者需调整消融靶点提高消融成功率 ;有房室传导阻滞先兆者采用时间滴定法 ,可避免永久性房室传导阻滞发生。

To assess the relation between electrophysiological changes and clinical efficacy of slow atrioventricular(AV) nodal pathway ablation in patients with AV nodal reentrant tachycardia (AVNRT). Ninety four patients with slow fast AVNRT were treated by slow AV nodal pathway ablation. Electrophysiological study (EPS) was applied before?during and after ablation. End points of slow pathway ablation were evaluated. Ablation was successful in all patients. Of 94 patients, slow pathway conduction was completely blocked in 75 patients, not completely blocked in 19 patients. Of whom 2 had 1～2 AVN echoes. During follow up (mean 28±17 months), 4 patients had recurrent AVNRT 1～5 months after ablation and required second ablation. Five patients who had sustained junctional rhythm (JR) during delivery of radiofrequency (RF) energy still remained AVNRT after delivery of RF energy. The ablation was finally successful after changing ablation target. 'Time Titration' was successfully accepted for 4 patients with aura of AV block during delivery of RF energy. [Conclusion] Ideal end point for slow pathway ablation should be no inducible AVNRT post ablation. The appearance of persistent JR is safe. To change ablation target could enhance the successful rate in a few patients. 'Time Titration' is an optional way for these patients with aura of AV block during slow AV nodal pathway ablation, which could avoid permanent AV block.