【摘要】 目的探讨冷冻消融治疗房室间隔区域旁路(AP)和房室结折返性心动过速(AVNRT)的疗效、安全性和电生理特征。方法13例AVNRT和4例(5条AP)房室折返性心动过速(AVRT)患者进行冷冻消融(CA)治疗。所有病例术中均进行基础心内电生理检查,然后进行冷冻标测(CM)和CA,以达到即刻终点为目标。结果13例AVNRT和3条右间隔AP用CA法成功阻断间隔区域的折返环路。在冷冻过程中发现暂时性房室传导阻滞(AVB)8次(CM时3次,CA时5次),停止冷冻作用后房室传导功能迅速恢复。1例在CA时有短暂一过性交接性心律。在4～8周的随访中,无复发病例和与冷冻有关的并发症发生。结论CA治疗间隔区域参与的心动过速是安全、有效的方法,尤其是对AVNRT患者。在产生永久损伤之前,CM和CA前期可逆消融能够筛选出可靠的消融点,利用这种优势来避免不可逆房室传导阻滞的发生。更多还原

【Abstract】 Objective To evaluate efficacy, safety and electrophysiologic Characteristics of Cryo-ablation in treatment for accessory pathway (AP) located near the atrioventricular junction and for atrioventricular nodlal re-entrant tachycardia (AVNRT). Methods Thirteen patients with AVNRT, 4 patients with AVRT underwent cryo-ablation (CA). Electrophysiologic study was performed with diagnostic catheters. Cryoablations was performed before Cryomapping (CM), to identify the site for safe arrhythmia ablation. Acute end points were noninducibility of AVNRT by programmed atrial stimulation performed 30 min after procedure, as well as noninducibility and conduction block over the AP. Results Thirteen cases with AVNRT and 3 cases with right septal AP were succeeded with cryothermal catheter. Transient atrioventricular block (AVB) occurred during 8 cryo-applications (3 CM, 5 CA) with immediate return of normal AV conduction upon cessation of application. Transient accelerated junctional tachycardia was seen in only one case during CA. During follow-up (range: 4 to 8 weeks), no patient had arrhythmia recurrence and permanent cryo-related complications. Conclusion Cryo-ablation was effective and safe for septal tachycardia in this group. Cryo-mapping and early CA was able to test functionality of prospective site before permanent lesion. This technique was some distinct advantages to reduce occurrences of inadvertent AV block.更多还原