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慢径路消融改良房室结术中出现的交界性心律之特征
http://www.100md.com 《广西医科大学学报》 2000年第1期
     作者:任法鑫 朱立光 赵定箐 陶新智 曾智恒 郑剑光 冼健坤 黄锦玲

    单位:广西医科大学心血管病研究所 南宁 530021

    关键词:房室结折返性心动过速;射频导管消融;交界性心律;房室结改良术

    广西医科大学学报000123

    摘要 目的:分析房室结慢径路消融术中出现的一过性交界性心律(JR)的特征。方法:21例(男6例,女15例)进行房室结改良术的房室结折返性心动 过速患者,术中详细记录释放射频的次数、能量、持续时间、以及出现一过性交界性心律的 时间、频率及数目,比较释放射频有效时/无效时出现的一过性交界性心律之特征有无显著 性差异。结果:共进行106次射频电流释放,其中21次有效(A组),85次无效( B组)。A组有19次出现JR,B组有22次出现JR(P<0.05);JR的平均出现时间为6 s,A组 有10次,B组有4次出现的JR在释放射频后6~10 s(P<0.05);每次JR的平均个数为7个 ,A组有13次,B组有7次出现的JR个数大于7(P<0.05);JR频率中位数为110次/min,A 组有8次,B组有14次的JR大于110次/min(P>0.05)。结论:慢径路改良过程中出现的一过性JR是消融导管接近靶点的标 志,JR的个数越多、出现时间在放电后6~10 s则消融成功的可能性愈大。
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    中国图书资料分类法分类号 R454

    CHARACTERISTIC OF JUNCTIONAL RHYTHM DURING RADIOFREQUENCY CATHETER ABLA TION OF SLOW PATHWAY IN ATRIOVENTRICULAR NODAL REENTRANT TACHYCARDIA

    Ren Faxin,Zhu Liguang,Zhao Dingqing

    (The Cardiovascular Disease Institute of Guangxi Medical University,Nanning 530021 China)

    Abstract Objective:To study the quantitative and qualitive as pects of junctional rhythm (JR) during RFCA of slow pathway in atrioventricular nodal reentrant tachycardia (AVNRT) patients.Methods:21 patients (6 males 15 females,ages raging from 23 t o 68 ys,mean age 39+-9) with AVNRT,underwent RFCA of slow pathway.During R FCA applications,electrocardiograph was continuously recorded.The recordings were posteriorly used to study the presence and characteristics of JR (numbers of episodes,freq uency and time of onset )at the effective and ineffective radiofrequency session s.All variables were expressed as median.Univariate analysis of the effects of each variable on success or fa ilure of ablation were performed,using x2-test.A P-value <0.05 was conside red significant.Results:106 radiofrequency sessions were performed,21 effecti ve and 85 ineffective(mean per patient 5,range from 1 to 17).JR was present in 19 of 21 effctive and 22 of 85 ineffective sessions (P<0.05).Median of ti me of appearance was 6 seconds,occurring between 6 and 10 seconds in 10 of 19 e ffective and in 4 of 22 ineffctive sessions (P<0.05).Median of number of e pisodes was 7,ocurring higher number in 13 of 19 effective and 7 of ineffective sessions (P<0.05).Median of frequency of JR was 110 bpm,8 of 19 effectiv e and 14 of 22 ineffctive sessions (P>0.05).Conclution:JR during slow pathway ablation is a sensitive mark er of ablation success.JR as a predictor of success has higher number of episod es and more occur rences between 6 and 10 seconds than that one of ineffective s essions.
, 百拇医药
    Kay words atrioventricular node;atrioventricular nodal reent rant tachycardia;radiofrequency catheter ablation;junctional rhythm

    射频消融术已成为根治快速性心律失常的重要手段[1],其中房室结慢径路消 融已是治疗房室结折返性心动过速(AVNRT)的主要方法。在此过程中,一过性交界性心律(JR )的出现是消融导管接近靶点的标志之一[2]。我们总结近年来成功进行房室结改良 术的病例,分析术中出现的一过性交界性心律的特征。

    1 材料与方法

    1.1 对象:1997年10月至1999年3月经食管调搏及心内电生理确诊的21例AVNRT患者(男6例,女15例),年龄23~68岁,平均39岁。
, 百拇医药
    1.2 研究方法:①房室结改良:所有病人均采用下/后位法进行房室结改良术,消融导管的定位依下列步骤进行[3]:在右前斜位30~40°透视下,消融导管经股静脉送入右房,导管尖端沿三尖瓣环详细标测,记录到His束电位(H波)后向下弯曲导管尖端,并沿三尖瓣环向冠状窦口近房间隔处缓慢后撤至H波消失,同时A/V比值在0.1~0.5之间时释放射频(20W),每次放电时间在10s左右,如无JR出现或心动过速终止则停止,否则,则放电30~60s以巩固效果;②改良成功标准[4]:①AVNRT终止且不能再被诱发;②静滴异丙肾上腺素(1μg/min)仍不能诱发;③慢径路前传功能丧失,重复电生理检查无AH跃增现象。

    1.3 资料收集:术中常规记录高位右房(HRA)、希氏束电位(His)、冠状窦电位(CS)及体表心电图,记录释放射频的次数及每次持续时间、JR出现的时间、频率、个数。统计释放射频的总次数,并按是否有效分为两组:A组(有效),B组(无效)。
, 百拇医药
    1.4 数据处理:各变量均用中位数表示,取P<0.05为有显著性差异,采用SPSS+软件包进行处理,组间比较用χ2检验。

    2 结 果

    共放电106次,有21次(A组)有效,85次(B组)无效,(每个病人平均放电约5次),在A组有19次B组22次出现JR(P<0.05);(有2例一次消融成功未出现JR)JR平均出现时间为6 s ,A组有10次B组有4次出现的JR在6~10 s内出现(P<0.05);JR的平均个数为7个,A组 有13次B组有7次出现的JR个数大于7个(P<0.05);JR的频率之中位数为110次/min,A组 有8次B组有14次出现的JR频率大于110次/min (P>0.05)(见表1)。

    参 考 文 献

    1,胡大一,黄永麟.射频电流导管消融术治疗心律失常.第2版.哈尔滨:黑龙江 科技出版社,1997.1-4.
, 百拇医药
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, 百拇医药
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    8,Lee Ma,Morady F,Ladish A,et al.Catheter modification of the atriovent ricular junction with radiofrequency energy for control of atrioventricular noda l reentry tachycardia.Circulation,1991,83:827.
, 百拇医药
    9,Kuo CT,Lauer MR,Young C,et al.Electrophysiologic significance of dis crete slow potentials in dual atrioventricular node physiology:implications for selective radiofrequency ablation of slow pathway conduction .Am Heart J,1996, 131(3):490-498.

    10,Lin JL,Lin FY,Lo HM,et al.Perinodal slow potential as a local guide for transcatheter radiofrequency ablation of atrioventricular nodal reentrant t achycardia:efficacy and electrophysiological mechanisms of success.Br Heart J,1 995,74(3):268-276.
, 百拇医药
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    收稿日期:1999-10-16, http://www.100md.com