摘要
目的研究射频消融术对室上性心动过速的疗效及方法学。方法对5 0 8例室上性心动过速患者行射频消融术,旁路在心室最早激动点(EVA)或心房最早激动点(EAA)消融,双径路则采用慢径改良或快径消融。结果5 0 8例患者中,房室旁路3 13例( 3 3 0条旁路) ,双径合并左侧旁路3例、右侧旁路2例,房室结双径路(DP) 190例;总体成功率98 0 3 % ;旁路消融7例复发,慢径改良消融中6例复发,但二次消融成功;并发症为股动脉、股静脉栓塞各2例,静脉栓塞1例,心包填塞1例,永久性Ⅲ度房室传导阻滞2例。结论EAA、EVA标测是旁路消融成功关键;后间隔旁路消融,A波较小,消融主要看X线影像定位;即使在远离HIS束区消融,慢径消融亦能造成Ⅲ度房室传导阻滞;故放电以“点射”结合时间递增法为宜;温控消融可提高成功率,减少复发率;术前、术后应常规服用巴米尔以预防栓塞。
Objective To study the method and efficacy of radiofrequency ablation(RFCA) for supraventricular tachycardia(SVT). Methods 508 cases with SVT were treated by RFCA. The accessory pathway (AP) ablation was performed in the earliest ventricular action(EVA) or the earliest atrial action(EAA). For the double pathway(DP), the slow or fast pathway(SP, FP)ablation was performed. Results A success rate of 98.01% was obtained in the series of 508 patients(313 cases of AP,190 DP, 5 combined DP and AP). Tachycardial recurred in 7 cases of AP and 6 DP(SP ablation), which were cured by reablation. The complication occurred included femoral artery occlusion(2 cases), femoral vein occlusion(2 cases), popliteal vein occlusion(1 cases), pericardial occlusion(1 cases),persistent Ⅲ-AVB(2 cases). Conclusion ①The mapping of EAA and EVA is the key to the success of AP ablation. ②X ray location plays an important role in the ablation of postseptal AP. ③Ⅲ-AVB was likely to occur in SP modification ablation, even when the site of ablation is in some distance to the HIS bundle. Hence it is advised to administer interrupted 'firing' with the power increased step by step. ④Temperature control ablation may increase success rate and decrease recurrent rate in the treatment of SVT. ⑤Aspirin should be taken before and after ablation operation for preventing the vessel occlusion.
出处
《实用临床医药杂志》
CAS
2005年第3期31-33,共3页
Journal of Clinical Medicine in Practice
关键词
射频消融
心动过速
旁路
双径路
radiofrequency ablation
tachycardia
accessory pathway
double pathway
