快速房性心律失常的电生理研究和射频导管消融治疗(摘要)
作者：马坚 王方正 楚建民 余培桢 王锦志 张奎俊 华伟 张澍
单位：北京市，中国医学科学院 中国协和医科大学 心血管病研究所 阜外心血管病医院 临床电生理研究室(100037)
关键词：
目的 目的：报道我院对房性心动过速(房速)和典型心房扑动(房扑)的电生理研究和射频导管消融术治疗。
方法：共56例患者。32例房速(37±17岁)中阵发性房速30例，慢性房速2例。24例房扑(55±14岁)中阵发性房扑8例，持续性房扑16例。经静脉放置CS、HBE、RVA和Halo电极导管，心房刺激诱发房速和房速时静脉注射ATP 20～30 mg,观察诱发方式和ATP的作用。分别起搏刺激激冠状窦口和右心房下壁，分析房扑患者的右心房激动顺序和传导时间。以激动顺序标测法确定房速的消融靶点，选择A-P′间期≥25 ms的部位进行消融；以解剖影像定位法，线性消融下腔静脉—三尖瓣环峡部或三尖瓣环—欧氏嵴峡部。成功消融终点：心房刺激不再诱发房速；房扑患者的峡部发生完全性双向阻滞。
, http://www.100md.com
结果：30例阵发性房速，心房刺激均反复诱发，且ATP终止率为87%，提示折返机制；2例慢性房速为自律性增加。成功消融31例，无任何并发症。平均放电6.3±3.4次，有效和无效靶点的A-P′间期分别为38±11 ms和26±7 ms(P<0.05),成功消融部位多位于心房特殊解剖区域。16例持续性房扑，右心房激动为单一逆时针或顺时针方向；心房起搏时，8例阵发性房扑的右心房激动呈双向性。所有房扑患者均消融成功，平均放电4.1±2.2次；消融后心房起搏，右心房激动为单一方向。随访15±4个月，2例房速和1例房扑复发，再次消融成功。
结论：射频导管消融术是根治快速房性心律失常的有效方法，安全可靠、术后复发率低。成年人阵发性房速的主要发病机制为折返性，并对ATP敏感；心房内冠状窦口、房室瓣环、终末嵴和肺静脉口部等特殊解剖区域是房速的好发部位和成功消融靶点。右心房后位峡部是典型房扑折返环的关键部位，该部位发生双向阻滞是消融治疗房扑成功的可靠标志。
Electrophysiologic Study and Radiofrequency Catheter Ablation for Rapid Atrial Arrhythmia (Abstract)
, 百拇医药
Department of Clinical Electrophysiology, Cardiovascular Institute and Fu Wai Hospital, CAMS and PUMC, Beijing (100037)
Ma Jian, Wang Fangzheng, Chu Jianmin, et al.
Objective: To report the results of electrophysiologic study and radiofrequency ablation for patients with atrial tachycardia and patients with typical atrial flutter.
Methods: There were fifty-six patients, including thirty-two with atrial tachycardia (AT, mean age 37±17 years, paroxysmal AT in 30 cases and chronic AT in 2 cases) and twenty-four patients with atrial flutter (AFL, mean age 55±14 years, paroxysmal AFL in 8 cases and persistent AFL in 16 cases). AT was induced by atrial stimuli, and intravenous adenosine triphosphate (ATP) 20～30 mg was given during AT. The mapping and ablating catheter is positioned in the right or left atrium to locate the ablation target site with earliest atrial activation of AT. Radiofrequency ablation at the inferior vena cava-tricuspid annulus or the tricuspid annulus-Eustachian ridge isthmus was performed in 24 patients with AFL. Successful ablation endpoints: AT not induced for AT patients; and bidirectional conduction block at isthmus for AFL patients.
, 百拇医药
Results: The suspected mechanism of paroxysmal AT in 30 patients was related to reentry, and in the other 2 cases with chronic AT was probably due to abnormal automaticity. ATP was effective in terminating 87% of the paroxysmal AT. AT was successfully ablated in 31 patients. The mean local endocardial electrogram timing relative to P-wave onset was 38±11 ms at successful ablation sites, which was significantly longer than that at unsuccessful ablation sites (26±7 ms, p<0.05). Radiofrequency ablation was performed during atrial flutter in 16 patients or during sinus rhythm in the other 8 patients; complete ischmus bidirectional block was achieved in all 24 patients. During a follow-up of 15 months, tachycardia recurred in 2 patients with AT and in 1 with AFL. However, second ablation was successful in these three patients.
Conclusion: Radiofrequency ablation had shown to be an effective method to treat AT and AFL. It is suggested that the major mechanism of AT in adult patients is reentry, and reentrant AT is adenosine-sensitive. Isthmus bidirectional conduction block is a reliable marker for successful atrial flutter ablation., 百拇医药
单位：北京市，中国医学科学院 中国协和医科大学 心血管病研究所 阜外心血管病医院 临床电生理研究室(100037)
关键词：
目的 目的：报道我院对房性心动过速(房速)和典型心房扑动(房扑)的电生理研究和射频导管消融术治疗。
方法：共56例患者。32例房速(37±17岁)中阵发性房速30例，慢性房速2例。24例房扑(55±14岁)中阵发性房扑8例，持续性房扑16例。经静脉放置CS、HBE、RVA和Halo电极导管，心房刺激诱发房速和房速时静脉注射ATP 20～30 mg,观察诱发方式和ATP的作用。分别起搏刺激激冠状窦口和右心房下壁，分析房扑患者的右心房激动顺序和传导时间。以激动顺序标测法确定房速的消融靶点，选择A-P′间期≥25 ms的部位进行消融；以解剖影像定位法，线性消融下腔静脉—三尖瓣环峡部或三尖瓣环—欧氏嵴峡部。成功消融终点：心房刺激不再诱发房速；房扑患者的峡部发生完全性双向阻滞。
, http://www.100md.com
结果：30例阵发性房速，心房刺激均反复诱发，且ATP终止率为87%，提示折返机制；2例慢性房速为自律性增加。成功消融31例，无任何并发症。平均放电6.3±3.4次，有效和无效靶点的A-P′间期分别为38±11 ms和26±7 ms(P<0.05),成功消融部位多位于心房特殊解剖区域。16例持续性房扑，右心房激动为单一逆时针或顺时针方向；心房起搏时，8例阵发性房扑的右心房激动呈双向性。所有房扑患者均消融成功，平均放电4.1±2.2次；消融后心房起搏，右心房激动为单一方向。随访15±4个月，2例房速和1例房扑复发，再次消融成功。
结论：射频导管消融术是根治快速房性心律失常的有效方法，安全可靠、术后复发率低。成年人阵发性房速的主要发病机制为折返性，并对ATP敏感；心房内冠状窦口、房室瓣环、终末嵴和肺静脉口部等特殊解剖区域是房速的好发部位和成功消融靶点。右心房后位峡部是典型房扑折返环的关键部位，该部位发生双向阻滞是消融治疗房扑成功的可靠标志。
Electrophysiologic Study and Radiofrequency Catheter Ablation for Rapid Atrial Arrhythmia (Abstract)
, 百拇医药
Department of Clinical Electrophysiology, Cardiovascular Institute and Fu Wai Hospital, CAMS and PUMC, Beijing (100037)
Ma Jian, Wang Fangzheng, Chu Jianmin, et al.
Objective: To report the results of electrophysiologic study and radiofrequency ablation for patients with atrial tachycardia and patients with typical atrial flutter.
Methods: There were fifty-six patients, including thirty-two with atrial tachycardia (AT, mean age 37±17 years, paroxysmal AT in 30 cases and chronic AT in 2 cases) and twenty-four patients with atrial flutter (AFL, mean age 55±14 years, paroxysmal AFL in 8 cases and persistent AFL in 16 cases). AT was induced by atrial stimuli, and intravenous adenosine triphosphate (ATP) 20～30 mg was given during AT. The mapping and ablating catheter is positioned in the right or left atrium to locate the ablation target site with earliest atrial activation of AT. Radiofrequency ablation at the inferior vena cava-tricuspid annulus or the tricuspid annulus-Eustachian ridge isthmus was performed in 24 patients with AFL. Successful ablation endpoints: AT not induced for AT patients; and bidirectional conduction block at isthmus for AFL patients.
, 百拇医药
Results: The suspected mechanism of paroxysmal AT in 30 patients was related to reentry, and in the other 2 cases with chronic AT was probably due to abnormal automaticity. ATP was effective in terminating 87% of the paroxysmal AT. AT was successfully ablated in 31 patients. The mean local endocardial electrogram timing relative to P-wave onset was 38±11 ms at successful ablation sites, which was significantly longer than that at unsuccessful ablation sites (26±7 ms, p<0.05). Radiofrequency ablation was performed during atrial flutter in 16 patients or during sinus rhythm in the other 8 patients; complete ischmus bidirectional block was achieved in all 24 patients. During a follow-up of 15 months, tachycardia recurred in 2 patients with AT and in 1 with AFL. However, second ablation was successful in these three patients.
Conclusion: Radiofrequency ablation had shown to be an effective method to treat AT and AFL. It is suggested that the major mechanism of AT in adult patients is reentry, and reentrant AT is adenosine-sensitive. Isthmus bidirectional conduction block is a reliable marker for successful atrial flutter ablation., 百拇医药