导管电极电灼房室交界治疗室上性心律失常3例报告

ABLATION OF ATRIOVENTRICULAR JUNCTION THROUGH CATHETER ELECTRODE IN THE TREATMENT OF SUPRAVENTRICULAR ARRYTHMIA: A REPORT OF 3 CASES

对药物难以治疗的室上性心律失常3例,采用了导管电极电灼房室交界的治疗技术。多极导管经股静脉插入横跨三尖瓣口记录希氏束图,用最大希氏束电势的电极施行R波同步电击,每例电击1～2次,能量200～360J。3例均为Ⅲ度房宣传导阻滞,监测48～72h,后安装永久起搏器,随访6～12个月,均为起搏心律,无室上性心动过速发作,亦无并发症。讨论了电灼房室交界的指征,操作注意事项,治疗效果和血清酶学改变。

In order to terminate a drug-refractory supraventricular arrhythemia,three patients underwent an electrical ablation of atrioventricular junction through a catheter electrode.A multipolar electrode catheter was inserted into the femoral vein,positioned just across tricuspid orifice to record His bundle electrogram,while showing largest His bundle deflection,a R-wave synchronised electrical shock was deliveved.Each patient was shocked once or twice,with total intensity of 200~360 joules.Permanent pacemakers were implanted in all the 3 patients after 48~72 hour monitering for their Ⅲ° atrioventricular block.A pacing rhythm was maintained in all the patients,and no episode of supraventricular tachycardia was found during 6~22 month follow-up.No complication occurred in these cases.The indications of electrical ablation of atrioventricular junction,precautions which should be observed in the procedure,the results of the treatment,and the changes in serum enzyme spectrum were discussed.