【摘要】 目的观察希氏束旁路导管冷冻消融的安全性和有效性,并分析消融靶点的电生理特点。方法经冷冻消融治疗的希氏束旁路所致的房室折返性心动过速病例15例,其中显性希氏束旁路6例,5例由外院经电生理检查确认为希氏束旁路放弃消融或经消融失败后转来我院。所有病例采用-25℃冷冻标测确认为有效靶点,-60℃冷冻消融,以消融成功靶点记录到希氏束电位来确定为希氏束旁路。结果15例病例有效靶点均记录到清晰的希氏束电位,靶点希氏波振幅(0.126±0.082)mV,其中振幅≥0.1mv 8例(53.3%),心动过速时靶点处V-A间期(38.7±4.4)ms;冷冻导管与心内膜发生粘附平均温度为(-19.3±2.2)℃,从开始降温到发生粘附所需时间为(21.5±2.9)s;冷冻标测平均(3.8±2.4)次,冷冻消融1~3次,每次持续240s,手术时间(82.3±29.3)min;3例病例在Ensite Navx系统引导下进行手术,基本无X线曝光,其他12例病例X线曝光时间(14.6±7.9)min;所有病例术中均消融成功,没有消融相关并发症;在冷冻标测和冷冻消融过程中各出现短暂房室传导阻滞2例,停止冷冻消融复温后传导迅速恢复正常。术后随访,无延迟房室传导阻滞发生,无室上性心动过速复发。结论冷冻消融阻断希氏束旁路安全有效。更多还原

【Abstract】 Objective To evaluate the safety and efficacy of cryoablation in para-Hisian accessory pathways(Aps)and electrophysiologic characteristics of ablation target.Methods 15 consecutive patients with atrioventricular reciprocating tachycardia(AVRT) and para-Hisian APs underwent cryoablation.Of them,6 cases presented with overt para-Hisian AP.5 cases had para-Hisian AP determined by electrophysiologic test in other hospital and were transferred to our hospital after ablation failed.Ablation targets were determined by cryo-mapping at-25℃,followed by cryoablation at-60℃.Para-Hisia AP was determined by His potential recorded at successful ablation site.Results His potential was recorded clearly at successful ablation sites in all 15 cases with an average amplitude of 0.126 ±0.082 mv(>0.1mV in8 cases).Ventricular(V)-atrial(A) interval was of(38.7 ±4.4)ms during orthodromic AVRT.It took 21.5 ±2.9 seconds for the catheter tip to stick to target site with an average temperature of(-19.3 ± 2.2)℃;All APs were ablated successfully without complication,using 3.8 ±2.4 cryo-mapping,and 1-3 cryothermic applications(240s in each application).Procedure time was 82.3 ±29.3 min.The mean X-ray exposure was 14.6 ±7.9 min in 12 patients.Another 3 cases underwent cryoablation under the guide of Ensite Navx.Transient AV block occurred in 2 cases during cryo-mapping and AV prolongation in another 2 cases during cryoablation.AV conduction recovered immediately after cessation of cryoablation.There was no delayed AV block and recurrence of supraventricular tachycardia during follow-up of 12 months.Conclusion Cryoablation of para-hisian accessory pathways is safety and effective.更多还原