摘要
目的采用房室结有效不应期和文氏点、心房肌波长指数、心室率等指标的变化评价导管射频消融改良房室结治疗心房颤动（简称房颤）的疗效。方法９例患者，８例为阵发性房颤，１例持续性房颤。７例诊断特发性房颤。电生理检查与导管射频消融（“中位法”改良房室结慢径区域）一次完成。结果６例在窦性心律下行电生理检查并消融，５例成功，消融后房室结前传文氏点明显降低，有效不应期明显延长，房颤时最快心室率、平均心室率与房室结前传有效不应期和文氏点呈负相关。消融前后在希氏束区、冠状窦口、冠状窦中部的波长指数无明显变化，却明显短于对照组。２例在房颤时消融，１例成功，１例发生Ⅲ度房室传导阻滞。１例在房性心动过速时放电，成为稳定的２：１房室传导。成功率７７．８％，成功者在随访期间房颤时的最快心室率和平均心室率比消融前明显降低，房颤时无明显症状或只有轻微心悸感，其中３例阵发性房颤发作次数显著减少，１例无发作。结论射频消融是代替药物，又不用植入起搏器的一种较为安全有效的控制房颤心室率的方法。
Objective To eveluate the efficacy of atrioventricular node (AVN)modification on atrial fibrillation (Af) by radiofrequency catheter ablation (RFCA). methods Nine patients(6 males,3 females),8 with paroxysmal Af,one with persistent Af.Seven were diagnosed as lone Af.Electriophysiologic study and RFCA(AVN modification with “median” method)was performed in one session.Results Six were studied and ablated during sinus rhythm,but 5 were successful.Their AVN antegrade effective refractory period (ERP) and Wenckebach cycle length (WCL) were prolonged after modification.Maximum ventricular rate (MaVR) and mean ventricular rate (mVR) during Af were negatively correlated with ERP and WCL.The wavelength indices at His bundle,coronary sinus orifice,middle coronary sinus were not significantly changed after RFCA than before,but they were significantly shorter than that in control group.Two were ablated during Af,one succeeded,Ⅲ° AVB was obtained.One was ablated during atrial tachycardia,and 2:1 atrioventricular conduction was obtained.The successful rate was 77 8%.In successful cases,the MaVR and mVR during Af were significantly reduced in follow-up than before RFCA,there were no symptom or slight palpitation while Af episode,episodes were markedly reduced in 3 cases,no episode occurred in one case.Conclusion AVN modification by RFCA is a safe and effective method to control the ventricular rate of Af.
出处
《临床心电学杂志》
1999年第1期6-9,共4页
Journal of Clinical Electrocardiology
关键词
射频消融
房室结改良
心房纤颤
治疗
Atrial fibrillation AVN modification Ventricular rate
