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Koch三角下位与中位线性消融对治疗常规消融方法困难的房室结折返性心动过速的比较

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2009年第5期
页码:
693-695,705
栏目:
临床研究
出版日期:
2009-07-14

文章信息/Info

Title:
Comparison of linear ablation at low and mid-level of Kochs triangle in treatment of atrioventricular nodal reentrant tachycardia refractory to conventional slow pathway modification
作者:
吴峰; 冯金忠; 邱一华; 周巍; 俞峰; 张健; 骆合德
解放军第九八医院心内科，浙江 湖州 313000
Author(s):
WU Feng;  FENG Jin-zhong;  QIU Yi-hua;  ZHOU Wei;  YU Feng;  ZHANG Jian;  LUO He-de
Department of Cardiology, PLA 98 Hospital, Huzhou 313000, Zhejiang, China
关键词:
心动过速; 房室结折返性; 消融; 线性
Keywords:
atrioventricular nodal reentrant tachycardia;  linear ablation
分类号:
R541.71
DOI:
-
文献标识码:
A
摘要:
目的: 比较常规消融方法困难的房室结折返性心动过速(AVNRT)Koch三角下位与中位线性消融两种方法的有效性和安全性。方法: 回顾性分析比较常规消融方法困难的房室结折返性心动过速Koch三角下位线性消融（三尖瓣环至冠状窦口中部）和中位线性消融（三尖瓣环至希氏束与冠状窦口连线的中下1/3交界水平）的手术成功率、慢径消除率、放电时间和操作时间。结果: 下位和中位线性消融均具有较高的成功率（94.4%、100%）。在放电时间上，下位法消融组显著高于中位法线性消融［（578±177）ms vs ( 481±185)ms，P<0.01］，而整个手术操作时间，下位法组要明显低于中位法［（153±51）ms vs (199±56)ms，P<0.01）］。在消融过程中，中位法出现1例一过性Ⅰ度房室传导阻滞，两组无任何程度的持续房室传导阻滞发生。结论: 对常规方法消融后复发的AVNRT，Koch三角下位线性消融与中位线性消融方法均较为安全，但下位法可能操作更简洁。
Abstract:
AIM: To compare the efficacy and safety of low and mid-level linear ablations at Kochs triangle in the treatment of atrioventricular nodal reentrant tachycardia (AVNRT) refractory to conventional slow pathway modification. METHODS: In cases with AVNRT refractory to conventional ablation, elimination of slow pathway, rate of success, time of radiofrequency (RF) delivery and total procedure time were compared between the linear ablations at the low and mid-level of Kochs triangle. RESULTS: No significant difference was seen in the rate of success and the elimination of slow pathway between the groups. However, the time of RF energy delivery at the low level of Kochs triangle was longer than that of mid-level linear lesion ［(578.1±177.4)ms vs.(481.3±185.2)ms, P<0.01］. Moreover, the time needed for the total procedure was shorter by low linear ablation compared with that by mid-level linear ablation ［(152.8±51.2)ms vs.(198.6±56.1)ms, P<0.01］. One patient showed transient one-degree AV block during linear lesion at the mid-level of Kochs triangle and no permanent AV block occurred during the entire procedure. CONCLUSION: Both low and mid-level linear ablations at Kochs triangle are effective and safe in the treatment of the AVNRT refractory to conventional slow pathway modification. However, the procedures of low level linear ablation may be simpler, and mid-level linear ablation could be a backup approach.

参考文献/References

［1］ Nikoo MH, Emkanjoo Z, Jorat MV, et al. Can successful radiofrequency ablation of atrioventricular nodal reentrant tachycardia be predicted by pattern of junctional ectopy?［J］. J Electrocardiol, 2008, 41(1):39-43.

［2］ Estner HL, Ndrepepa G, Dong J, et al. Acute and long-term results of slow pathway ablation in patients with atrioventricular nodal reentrant tachycardia--an analysis of the predictivefactors for arrhythmia recurrence［J］. Pacing Clin Electrophysiol, 2005, 28(2):102-110.

［3］ Hayashi M, Kobayashi Y, Miyauchi Y, et al. A randomized comparison of the linear approach with electrogram mapping focal approach in selective slow pathway ablation［J］. Pacing Clin Electrophysiol, 2001, 24 (8 Pt 1):1187-1197.

［4］ Scheinman MM, Yang Y. The history of AV nodal reentry［J］. Pacing Clin Electrophysiol, 2005, 28(11):1232-1237.

［5］ Lin JL, Huang SK, Lai LP, et al. Radiofrequency catheter ablation of septal accessory pathways within the triangle of Koch: importance of energy titration testing other than the local electrogram characteristics for identifying the successful target site［J］. Pacing Clin Electrophysiol, 1998, 21(10):1909-1917.

［6］ Hwang HK, Wolff GS, Sun FJ, et al. The most common site of success and its predictors in radiofrequency catheter ablation of the slow atrioventricular nodal pathway in children［J］. Pacing Clin Electrophysiol, 2008, 31(10):1300-1306.

［7］ Fujii E, Kasai A, Omichi C, et al. Electrophysiological determinants of persistent dual atrioventricular nodal pathway physiology after slow pathway ablation in atrioventricular nodal reentrant tachycardia［J］. Pacing Clin Electrophysiol, 2000, 23(11 Pt 2):1916-1920.

［8］ 陈明龙, 曹克将, 陈椿, 等. Koch三角基底部线性消融治疗常规消融方法困难的房室结折返性心动过速［J］. 中华心律失常杂志, 2004, 8(5):261-265.

备注/Memo

备注/Memo:
收稿日期：2009-3-21.通讯作者：骆合德，主任医师，主要从事心脏电生理及射频消融Email:luohede98@163.com 作者简介：吴峰，硕士Email:sailing.wu@163.com
更新日期/Last Update: 2009-07-22