能量滴定法在慢径改良术中预防房室传导阻滞作用探究卢先本.docVIP

能量滴定法在慢径改良术中预防房室传导阻滞作用探究卢先本 ［ ］目的探讨“能量滴定法”在射频消融治疗房 室结折返性心动过速术中对房室传导阻滯的预防作用。方 法收集经射频消融术治疗的房室结折返性心动过速865 例；消融过程采用“下位法+能量滴定法”。结果治疗成功 率98.9%，复发率为2.08%，10例患者出现1°房室传导阻 滞，无nr房室传导阻滯发生。靶点数5.0、有效靶点/ 总靶点70%和累计消融能量(W*S)2300的患者房室传导 阻滞的发生率明显增高(P0. 05)，而复发率则无明显差异。 结论射频消融术治疗房室结折返性心动过速减少累计消融 能量、控制总靶点数和提高靶点有效率能有效减少房室传 导阻滯的发生。 ［关键词］房室结折返性心动过速；射频消融术；房 室传导阻滞；并发症；能量滴定法；有效靶点 分类号：R541. 7+6； R972 A文章编 号：1009-816X(2007)03 -0151-03 Preventing the Atrioventricular Block in RFC A for the treatment of AV NRT. LU Xian-ben, XU Gen, Tang Li-jiang, et al. Department of Cardiol ogy, The Second Affiliated Hospital of Medical College, Zhejiang University, Zhe jiang 310006, China [Abstract] Objective To discuss the prevention of atrioventric ular block during radio-frequency ablation (RFCA) for the treatment of atriovent ricular nodal reentrant tachycardia (AVNRT). Methods Total 865 p atients with atrioventricular nodal reentrant tachycardia treated with RFCA werestudied. Energy discharge approach was used. Results The succes s rate for AVNRT was 99.42%. Recurrence rate was 2.08%. 1° atrial-ventricularblock developed in 10 patients. The patients with target sites 》5.0, ratio of e ffective target sites/total sites 70% and total energy output (W*S) ^2300 wer e more likely to develop atrial-ventricular block (AVB) (P0. 05). There wasno remarkable difference in the recurrence rate. Conclusions Du ring RFCA for the treatment of AVRT, decrease the total energy output and the ta rget sites, increase the effective target sites can decrease the occurrence of A VB. [Key words] Atrioventricular nodal reentrant tachycardia； Radi o-frequency catheter ablation (RFCA)； Atrial-ventricular block (AVB)； Complicati on； Energy discharge approach； Effective target site 经导管射频消融治疗房室结折返性心动过速 (atrioventricular nodalreentrant tachycardia, AVNRT) 已被证实是首选、有效的方法。总体成功率在98.8% ［1］， 但在治疗操作过程中各种原因导致并发症的发生是不可避 免的，总体发生率在0. 8%［1］，其中最常见也最严重的并 发症是 111° 房室传导阻滞(atrioventricular bl ock，AVB) 的发生率在0.4?0.8% ［ 1?3］。我们回顾分析了我院及浙 江大学医学院附属第二医院的部分行射频消融