【作者】 裘存新；

【导师】 彭景添；

【作者基本信息】 江西医学院 ， 内科学， 2005， 硕士

【摘要】 【目的】分析射频消融术(RFCA)治疗快速性心律失常的临床特点,旨在进一步揭示其发生机制,提高识别术中不典型病例及特殊电生理现象的分析能力,为临床提供实用性参考价值。【方法】回顾分析我院2004年行心内电生理检查和射频消融治疗的122例患者,其中男62例, 女60例, 年龄13～76 岁, 平均(42.7±15.5)岁;初发年龄8～73岁(平均33.5±15.2岁);发作病史2天～32年(平均9.2±9.0年);分析其术前体表心电图(ECG)、食管电生理检查(EPS)、术中心内电生理系统检测、靶点标测、消融放电和术后随访情况等资料。着重分析快速性心律失常中临床最常见的房室结折返性心动过速(AVNRT)和房室折返性心动过速(AVRT)体表ECG、心腔内电图的特点和术中出现的特殊的电生理现象。【结果】本研究122例患者中AVNRT 53例(含5例房室结双径路(DAVNP)术中未诱发,严格来说不能归AVNRT) ,占总体入选病例的43.4%;AVRT 60例,占总体入选病例的49.2%; AVRT中,显性旁道28例,隐匿性旁道32例,各占AVRT的46.7%(28/60)、53.3%(32/60);房性心动过速(简称房速,AT )2例(其中1例为并发);心房扑动(简称房扑,AFL)2例(其中1例亦为并发);特发性室性心动过速(IVT) 3例;多源性室性心动过速(VT) 3例;EPS检查正常1例。食管EPS共92例,占总例数的75.4%(92/122),其中AVNRT和隐匿性旁道(CAP)的食管EPS例数分别为46、27,分别占86.8%(46/53)、84.4%(27/32), 检出(包更多还原

【Abstract】 【Objective】The purpose of this paper was to further reveal the mechanisms and improve the abilities of identifying atypical cases or special electrophysiological phenomena by analyzing the clinical outcomes of patients with tachycardia who had been undergone radiofrequency catheter ablation, thus providing guidelines for further clinical work. 【Methods】The clinical outcomes of 122 patients with tachycardia who had been undergone intracardiac electrophysiologic study(EPS) or radiofrequency catheter ablation (RFCA) were retrospectively analyzed. The patient population comprised 62 men and 60 women aged 13 to 76 (42.1±15.5)years old and the history of tachycardia was 2 days to 32(9.2±9.0) years. The clinical data of all cases of tachycardias who had been undergone intracardiac EPS or RFCA were analyzed, including the surface electrocardiograph(ECG), the transesophageal EPS , intracardiac EPS , target mapping, ablation and their follow-up. Especially, the unusual electrophysiological features of the most common tachycardias such as atrioventricular nodal reentrant tachycardia(AVNRT) and atrioventricular reentrant tachycardia(AVRT) during intracardiac EPS and RFCA were studied. 【Results】Among analyzed 122 cases, there were 53 cases of AVNRT( about 43.4%, including 5 patients with dual atrioventricular node pathways but uninducical tachycardia who had paroxysmal palpitation; strictly, these cases did not belong to AVNRT), 42 cases with antrogradely “jumping”conduction, 2 cases with retrogradely “jumping”conduction and 4 cases without “jumping”conduction but inducical tachycardia. There were 60 cases of AVRT(about 49.2%), with 61 accessory pathways(AP) including 49 left AP(47 cases of single AP and 1 case of double AP) and 12 right accessory pathways. Among all the cases of AVRT, there were 32 cases of concealed accessory pathways (CAP) and 28 cases of WPW(Wolff-Parkinson-White syndrome)(adout 53.3%,46.7%,respectively). In addition, there were 6 cases of ventricular tachycardiac(VT) with 3 cases of IVT, 2 cases of atrial tachycardiac(AT) and 2 cases of atrial flutter(AFL). esophageal EPS had been performed in 92 patients (about 75.4%), including 46 cases of AVNRT and 27 cases of CAP. The detective rate was 84.8% and 67.7% respectively. 112 cases had been undergone RFCA . The overall success rate in first session was 97.3%(109/112), in which AVNRT and AVRT had high success rate (about 99.1%). After a follow-up of 5 to 17 months, The recurrence was found in 3 patients(about 2.7%). No serious complication (such as complete atrioventricular block(AVB), pericardial tamponnade and pulmonary embolism) happened. 【Conclusion】radiofrequency catheter ablation can be performed effectively and safely in patients with tachycardia, especially in patients with AVRT and AVNRT. It could be clinically used as the first selection of therapy in some refractory tachycardia.更多还原