房室结折返性心动过速射频消融术后复发机制探讨
《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]
- 期数:
- 2009年第6期
- 页码:
- 810-812
- 栏目:
- 临床研究
- 出版日期:
- 2009-11-05
文章信息/Info
- Title:
- Analysis of recurrence of atrioventricular nodal reentrant tachycardia after radiofrequency catheter ablation
- Author(s):
- XIONG Hai-gang; SHAN Zhao-liang; WANG Yu-tang; SHI Xiang-min; YUAN Hong-tao; GUO Hong-yang; ZHANG Ye
- Department of Cardiology, PLA General Hospital, Beijing 100853, China
- Keywords:
- tachycardia; atrioventricular nodal reentrant; catheter ablation; radiofrequency; recurrence
- 分类号:
- R541.7
- DOI:
- -
- 文献标识码:
- A
- 摘要:
- 目的: 探讨房室结折返性心动过速射频消融术后复发原因。方法: 对356 例房室结折返性心动过速患者射频消融术后进行随访,回顾性分析其电生理资料。结果: 356例中10例复发,复发率2.8%，320例患者射频术后无心房回波，无跳跃现象，一直未复发；术后有心房回波无跳跃现象未诱发出室上速17例，其中3例复发；术后有跳跃及心房回波未诱发出室上速11例，其中5例复发；术后有跳跃无心房回波未诱发出室上速8例，2例复发。10例复发患者，第2次射频消融术后房室结不应期均较第1次术后延长，且与术前快径不应期差值明显减小，第2次射频消融术后随访至今（>9个月），无1例复发。结论: 慢径残存是房室结折返性心动过速射频消融术后复发的主要原因。
- Abstract:
- AIM: To investigate the cause of atrioventricular nodal reentrant tachycardia (AVNRT) recurrence after slow pathway radiofrequency catheter ablation (RFCA). METHODS: Three hundreds and fifty-six cases with AVNRT after RFCA were followed up and their electrophysiologic data were retrospectively analyzed. RESULTS: Ten of the 356 cases had recurrence (2.8%). No recurrence was observed in the 320 cases without an atrial echo and jump phenomenon after RFCA. Three cases recurred from the 17 cases with an atrial echo but no jump phenomenon in those where no supraventricular tachycardia (SVT) was induced after RFCA. Five cases recurred in the 11 cases with an atrial echo and jump phenomenon but no SVT after RFCA. Two cases recurred from the eight cases with jump phenomenon but no atrial echo and no SVT after RFCA. Among the 10 recurrent cases, atrioventricular nodal refractory period (AVNERP) after the second RFCA obviously lengthened compared with that after the first RFCA and the difference between AVNERP and fast pathway ERP obviously diminished. No recurrence was observed in the 10 recurrent cases who had been treated with a second RFCA (>9 months). CONCLUSION: Slow pathway remnant is the main cause of AVNRT recurrence after slow pathway RFCA.
参考文献/References
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［3］ John M, 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 predictive factors for arrhythmia recurrence［J］. Pacing Clin Electrophysiol, 2005, 28(2) :102-110.
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［6］ 刘少聪，林治湖，杨东辉，等. 射频消融慢径后心动过速复发与房室结电生理特性变化的关系［J］. 中国心脏起搏与心电生理杂志, 1998, 12（4）:31-33.
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［8］ 胡大一,陈新,马长生. 2000年全国射频导管消融治疗快速心律失常资料总汇［J］. 中国心脏起搏与心电生理杂志, 2001, 15(6):368-370.
［9］ L i HG, Klein GJ, Stites HW, et al. Elimination of slow pathway conduction: an accurate indicato r of clinical success after radiofrequency atrioventricular node modification［J］. J Am Coll Cardiol,1993, 22(7):1849-1953.
［10］Jackman WM, Beckman KJ, McClelland JH, et al. Treatment of supraventricular tachycardia due to atrioventricular nodal reertry by radiofrequency catheter ablation of slow-pathway conduction［J］. N Engl J M ed, 1992, 327(5):313-318.
备注/Memo
- 备注/Memo:
- 收稿日期：2008-11-17.通讯作者：单兆亮，副主任医师，副教授，主要从事心脏电生理及起搏的临床和基础工作研究Email:shanzl301@sina.com 作者简介：熊海刚，主治医师，硕士生Email:xionghaigang@126.com
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