射频消融房室结慢径术发生房室传导阻滞的探讨

The evaluation of atrioventricular block in radiofrequency catheter ablation treatment of atrioventricular slow pathway

目的 :分析房室结折返性心动过速 (AVNRT)患者射频消融术 (RFCA)术中、术后发生房室传导阻滞 (AVB)与靶点选择的关系 ,以探讨选择消融靶点的安全性。方法 :选取 AVNRT患者 97(男 34,女 6 3)例 ,在窦性心律下行RFCA,每次放电前多导生理记录仪记录靶点图 ,放电时观察并用多导生理记录仪记录体表心电图及腔内电生理图 ,分析靶点选择与 AVB发生的关系。结果 :在靠近冠状窦口电极的 C区消融时 ,AVB发生率低 ,而在靠近希氏束电极的 A区消融时 ,AVB发生率高 ;靶电图中出现 His时 AVB发生率高 ;靶电图中 His波振幅高者 ,AVB发生率高 ;A/ V比值 <1时 AVB发生率低。结论 :尽量避免在 A区消融 ,RFCA中靶点图呈小 A大 V,不出现 His波均是避免发生 AVB的关键。

AIM:To analyse the relationship between atrioventricular block (AVB) and target selecting when and after the radiofrequency catheter ablation(RFCA) treatment of atrial ventricular nodal reentry tachycardia(AVNRT)patients. METHODS:97 patients (34 men and 63 women) of AVNRT were selected and were treated by RFCA when these patients were in sinus rhythm. The target graphs were recorded before electric discharging, the surface electrocardiograms and cardiac electrophysiological graphs were recorded when before electric discharging. The relationship between atrioventricular block(AVB) and target selecting was analyzed. RESULTS:The incidence of AVB is low when target is in C area (closing with orifice of coronary sinus), the incidence of AVB is high when target is in A area (closing with atrioventricular bundle), the incidence of AVB is high while His wave appears in the target graph or(and ) while amplitude of vibration of His wave is high, the incidence of AVB is low while the radio of A/V is below to 1. CONCLUSION:To abstain from electric discharge in A area and the target graph of RFCA with A/V<1(a little A wave,a big V wave )and no His wave are the key to avoid AVB.