微创医学

目的探讨阵发性室上性心动过速(PSVT)患者经导管射频消融术治疗后的临床效果。方法 350例阵发性室上心动过速患者,常规行心腔内电生理检查明确室上性心动过速类型。左侧房室旁道参与的折返性心动过速消融时采用主动脉瓣逆行途径或穿刺房间隔途径标测和消融,右侧房室旁道参与的折返性心动过速经右股静脉标测和消融,房室结折返性心动过速消融采用下位法消融慢径路。结果 350例阵发性室上性心动过速患者中,房室结折返性心动过速201例(57.4%),房室折返性心动过速149例(42.6%)。350例阵发性室上性心动过速患者手术即时成功率为99.4%(348/350),术后复发率2.9%(10/348)。350例PSVT患者的平均手术时间为(96.5±23.3)min,其中201例房室结折返性心动过速(AVNRT)患者的平均手术时间为(87.2±21.9)min,149例房室结折返性心动过速(AVRT)患者的平均手术时间为(98.4±26.6)min。350例PSVT出现手术并发症6例(1.7%),所有患者均无瓣膜损伤、心包填塞和死亡等严重并发症。结论射频消融治疗阵发性室上性心动过速安全、有效。术前完善发作时体表ECG和术中详细的心内电生理检查是明确诊断、提高疗效、减少并发症的关键。

Objective To evaluate the efficacy of radiofrequency current catheter ablation for patients with supraventricular tachycardia． Method 350 patients with paroxysmal supraventricular tachycardia were examined by electrophysiology to diagnosis the type of tachycardia． Patients with left-side accessory atrioventricular pathways were ablated by aortic retrograde pathway or puncture atrial septal pathway． Patients with right-side accessory atrioventricular pathways were ablated by right femoral vein． Patients with atrioventricular nodal reentrant tachycardia were ablated by inferior ablation of the slow pathway．Ｒesults 350 patients with paroxysmal supraventricular tachycardia， 201 were atrioventricular nodal reentrant tachycardia，and 149 were atrioventricular reentrant tachycardia． The Operation instant success rate was 99． 4%( 348 /350) ，and its relapse rate was 2． 9%( 10 /348) ． The total average operation time was ( 96． 5 ± 23． 3) min，among which the average operation time of was atrioventricular nodal reentrant tachycardia( AVNＲT) ( 87． 2 ± 21． 9) min，and the average operation time of atrioventricular reentrant tachycardia ( AVＲT) was( 98． 4± 26． 6) min． 6 patients had mild operation complications，but no severe complication such as valve injury，pericardial tamponade，or death occurred ． Conclusion Ｒadiofrequency current catheter ablation for patients with supraventricular tachycardia is safe and effective． Surface ECG during tachycardia and careful electrophysiology examination are important for making diagnosis， improving therapeutic effect，and decreasing complication．