房室结慢径路消融——有效放电过程的心电监测

【目的】探讨房室结慢径路消融有效放电过程心电监测的意义。【方法】 5 8例慢 快型房室结折返性心动过速在有效靶点以低射频能量 (15～ 2 5W )放电 ,监测心电变化 ,出现 :①交界区心律 >15 0min-1,②交界区心搏伴室房阻滞 ,③窦性心搏P R间期延长 ,视为房室传导阻滞的先兆 ,即刻终止放电 ,否则持续放电至交界区心搏逐渐减少或消失 ;若交界区心搏无减少 ,则持续放电至 90～ 12 0s。【结果】 5 8例房室结慢径路消融均获成功 ,有效放电过程均出现交界区心搏 ,放电时间 (12 8±2 6 )s,5 4例 1次消融成功 ,4例需 2次消融。 6例出现一过性房室传导阻滞 ,其中 4例于交界区心搏伴室房阻滞即刻停电后发生 ,2例于窦性心搏P R间期延长即刻停止放电后发生 ,无 1例出现永久性房室传导阻滞。随访 (18± 16 )月 ,2例复发 ,再经消融后未再复发。【结论】心电监测可指导射频能量的应用 ,从而提高房室结慢径路消融成功率 ,减少复发 ,避免永久性房室传导阻滞发生。

阵发性房室结折返性心动过速慢径路消融过程中交界心律的临床价值

目的:进一步明确在慢径消融过程中出现交界心律的临床价值。方法:回顾性分析我科1996年1月至2006年1月采用射频消融治疗的阵发性房室结折返性心动过速(AVNRT)患者425例。在慢径路消融过程中,以交界心律出现与否作为观察指标,按照常规的慢径路消融成功标准进行比较。结果:以交界心律出现与否作为观察指标,预示消融成功的敏感性97.91%,特异性68.67%,阳性预测值68.37%,阴性预测值97.94%,正确诊断指数0.67。结论:慢径路消融成功的病例在消融过程中大多出现交界心律,但交界心律的出现不能作为消融成功的终点;未出现交界心律提示我们需要重新调整导管的位置,寻找更有效的靶点。

房室结折返性心动过速的慢径路消融对进入房室结内的心房下部组织电生理特性的影响

The inferior atrial extensions of the atrioventricular(AV) node have been related to the anatomic substrate of the slow pathway, but their role in AV nodal reentrant tachycardia(AVNRT) is unknown. Ten patients with slow-fast AVNRT were studied before and after successful slow pathway ablation. Simultaneous His bundle recordings from the right and left sides of the septum were made during right and left inferoparaseptal pacing. Longer stimulus to His(St-H) intervals were measured during right inferoparaseptal pacing than during left inferoparaseptal pacing(284± 55 vs 246± 46 ms, p=0.005 for right His recordings and 283± 56 vs 244± 46 ms, p=0.005 for left His recordings) at similar coupling intervals during AVNRT induction. After ablation, the St-H intervals at the maximum AV nodal conduction decrement were similar during right inferoparaseptal and left inferoparaseptal pacing(217± 32 vs 207± 21 ms, p=0.10 for right His and 215± 32 vs 206± 20 ms, p=0.13 for left His) at similar coupling intervals. The difference(Δ St-H) between St-H intervals during AVRNT induction or at the maximum conduction decrement and during constant pacing for right His recordings with right inferoparaseptal pacing were significantly greater than Δ St-H measured with left His during left inferoparaseptal pacing(173± 64 vs 137± 55 ms, p=0.005) before ablation, but not after(117± 39 vs 100± 40 ms, p=0.44). Resetting of AVNRT with delivery of left inferoparaseptal extrastimuli was achieved in 7 of 10 patients. In conclusion, the electrophysiologic characteristics of the right and left inferior atrial inputs to the human AV node in patients with AVNRT and their response to slow pathway ablation provide further evidence that the inferior nodal extensions represent the anatomic substrate of the slow pathway.

温度指导的射频导管慢径路消融术的研究

在最近数年中,射频电流消融术发展迅猛,并已成为治疗房室结折返性心动过速(AVNRT)的主要手段。早有报导认为房室结快径路消融术疗效比较满意,但是,最近房室结慢径路消融术正在逐步取代快径路消融术,因为慢径路消融术的成功率达到了90％～100％,并且,导致房室传导阻滞(AVB)的危险性小。射频消融的效果有赖于与消融电极相接触的组织所接受的热量,包括直接的电产生的热量及间接传导的热量,因此,只有温度是射频消融效果的基础。电极与组织接触面的温度可以更可靠。

阵发性房室结折返性心动过速患者慢径路消融治疗的临床分析

目的探讨射频消融慢径路治疗阵发性房室结折返性心动过速(AVNRT)的临床效果。方法回顾性分析425例采用射频消融治疗的AVNRT患者的临床资料。结果417例手术成功,成功率98.12%。4例(0.94%)出现高度房宣传导阻滞,2例(0.47%)因心宣率较慢而安装永久性起搏器。随访6个月内有8例复发。复发率1.9%。结论选择性慢径路消融是成功治愈AVNRT安全有效的方法。