关键词：窦性心动过速，不适当的；窦房结改良术；导管消融，射频电流
摘要 报告1例不适当的窦性心动过速采用导管射频消融部分窦房结——窦房结改良术而成功治愈的病例。患者女性、63岁。心动过速史30余年。平时心率90 bpm以上，交感兴奋时高达210 bpm。心电图示窦性P波。心内电生理检查为起源于窦房结区的自律性增高的心动过速。用温控大头电极在最早兴奋的窦房结区上部放电，每次放电后略调整大头电极位置，使消融面积增大。自第6次放电10 s后A波频率降低，但停止放电后又增快；直至第16次放电停止后，A波频率不再增快。观察30 min，窦性心率从放电前210 bpm降至82 bpm。术后停用一切药物，随访两个月，窦性心律73～122 bpm，证实窦房结改良术成功。
Radiofrequency Catheter Modification of the Sinus Node on a Patient
With Inappropriate Sinus Tachycardia
Du Riying,Xue Yusheng,Wang Yi
(Department of Cardiology,Tangdu Hospital,the Fourth Military Medical University,Xian,710038)
Abstract Successful radiofrequency catheter ablation of a portion of the sinus node-the sinus node modification on a patient with inappropriate sinus tachycardia was reported.A woman aged 63 had had tachycardia for thirty years.Her heart rate was more than 90 bpm at rest and increased to 210 bpm on sympathetic excitement.It was sinus tachycardia on electrocardiogram and autonomic tachycardia from the sinus node on electrophysiologic test.Radiofrequency (RF) current was applied using 8 mm tip electrode with temperature control at the site of earliest atrial activation that was in the superior portion of the sinus node.The electrode was little moved after each RF application to expand the area of ablation.After 10 seconds discharge the atrial rate reduced,but it increased stopping discharge from the 6th to the 15th RF application.After the 16th RF application the atrial rate was reduced and stable.During 30 minuts observation,the sinus rate reduced to 82 bpm from 210 bpm before ablation.In follow-up of two months,the sinus rate was 73～122 bpm without any medicine that showed successful radiofrequency catheter modification of the sinus node.
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