您现在的位置: 范文先生网 >> 医学论文 >> 特种医学论文 >> 正文

窦性心律下射频导管消融起源于希蒲系统特发性室性心动过速的临床观察

时间:2006-11-26栏目:特种医学论文

  袁义强  刘怀霖   于力 王瑞敏 孙运 赵育洁  孙俊华  牛思泉  

    摘要 目的 探讨窦性心律下射频导管消融(RFCA)起源于希蒲系统特发性室性心动过速(IVT)的临床结果。方法 23例起源于希蒲系统IVT,按消融方法分为两组:⑴心动过速消融组,为9例患者,以心动过速下最早提前P电位为靶点,在心动过速下进行消融;⑵窦性心律消融组,为14例患者,以心动过速下记录最早P电位且窦律下试放电过程中出现同形或近似室性早搏及短阵室性心动过速为靶点,在窦律下进行消融。术后反复程序刺激不能诱发心动过速为消融终点。观察两种不同消融方法的临床结果。结果 两组在手术成功率、手术时间、X线曝光时间、并发症发生率及复发率方面无明显差别。结论 窦性心律下射频消融起源于希蒲系统IVT安全、有效。

    [关键词] 室性心动过速,左心室; 导管消融,射频电流

   Study the Clinical Results of Radiofrequency Catheter Ablation on Idiopathic Ventricular Tachycardia from His-Purkinje System During Sinus Rhythm. Yuan Yiqiang, Liu Huailin, Ma Yexin,et al.Division of Cardiology, Zhengzhou Seventh People`s Hospital, Zhengzhou, China.

    [Abstract] Objective Study the clinical results of radiofrequency catheter ablation on idiopathic ventricular tachycardia from His-Purkinje system during sinus rhythm. Method 23 idiopathic ventricular tachycardias, from His-Purkinje system,were divided into two groups in accordance with radiofrequency catheter ablation methods:⑴Tachycardia ablation group, There are 9 patients, whose abltion target sites are the earliest P potentials during IVT.And this group was ablated during tachycardia.⑵Sinus rhythm group, there are 14 patients, whose ablation target site are the earliest P potentials during tachycardia, and the ventricular prematures and ventricular tachycardias, which have same figure with the IVTs, appear when ablation begins during sinus rhythm. And this group was ablated during sinus. The ablation is successful if tachycardia can not be induced. We investigated the clinical results of two different ablation methods. Results There are no significant difference between success rate、process time、X ray time、complications and recurrence rate. Conclusion It is effective and safe to ablate IVT from His-Purkinje system during sinus rhythm

    [Key words] Ventricular tachycardia, left ventricle; Radiofrequency ablation

  随着射频导管消融(RFCA)治疗快速心律失常的广泛应用,其治疗特发性室性心动过速(IVT)的技术日臻成熟[1]。对于起源于希蒲系统的IVT,常规的方法是在心动过速下消融最提前P电位而获得成功。我们在实际工作中对一部分患者采用了术前确定最佳诱发条件,以心动过速下最早P电位靶点,然后终止心动过速,在窦性心律下消融,若试放电过程中出现与IVT同形或近似的室性早搏及短阵室性心动过速为有效靶点,以术后进行反复程序刺激不能诱发为消融终点,取得良好效果,现将结果报告如下。

   资料和方法

   临床资料 为1997年3月至2003年3月完成的23例起源于希蒲系统IVT患者,男13例,女10例,年龄19~61(平均年龄35±12)岁,其中3例合并高血压,术前心脏彩色多谱勒示心脏结构正常,心电图均呈右束支传导阻滞,电轴左偏或右偏。所有患者均用过抗心律失常药物,其中有9例患者长期服用心律平,效果欠佳。上述患者术前停用抗心律失常药物5个半衰期以上。
   电生理检查及RFCA
常规穿刺右颈内(或左锁骨下)及双侧股静脉,放置高位右心房(HRA)、希氏束(HBE)、冠状静脉窦(CS)及右室心尖部(RVA)标测电极。进行程序电生理检查(S1S1、S1S2、S1S2S3、S1S2S3S4),先后刺激心房、心室,必要时静滴异丙肾上腺素(1~3ug/min)使基础心率提高20%,诱发心动过速,观察是否有室房分离、室房递减传导,部分患者快速静注ATP(0.5mg/kg)。术中证实为希蒲系统IVT后穿刺右股动脉,送7F中弯或小弯消融导管致左心室间隔部,寻找P电位。据采用的消融方法分为两组:①心动过速消融组,为9例患者,以心动过速时最提前P电位靶点,若心动过速终止则为有效靶点,持续放电120秒,术后反复程序刺激不能诱发心动过速为消融终点。②窦性心律消融组,

[1] [2] 下一页

下页更精彩:1 2 3 4 下一页