补充线性消融房室结双径路残存慢径的临床分析
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摘要
目的:探讨房室结折返性心动过速(AVNRT)经常规方法消融后残存慢径采取Koch三角基底部补充线性消融后电生理特性变化以及临床疗效。
方法:160例AVNRT经常规方法消融成功后残存慢径患者49例,随机分为线性消融组(25例)和对照组(24例)。电生理检查分别记录线性消融前两组残存慢径路有效不应期(ERP)以及最大AH间期(A-Hmax),线性消融组残存慢径阻断率(如经线性消融残存慢径未能阻断则记录慢径路的ERP和A-Hmax的改变情况)以及两组复发情况。
结果:对照组残存慢径路平均ERP为288.6±56.0ms,平均A-Hmax306.9±52.0 ms。线性消融组补充消融前慢径路平均ERP为279±45.0ms,平均A-Hmax为312.9±66.8ms,两组术前各项参数比较无统计学差异(P>0.05)。线性消融组补充消融后15例慢径路阻断,未能阻断的10例慢径路平均ERP增加至310.6±67.0 ms,平均A-Hmax缩短为280.9±52.0ms,跟对照组比较差异具有统计学意义(P<0.05)。线性消融组术中1例出现一过性Ⅲ。AVB,停止放电后恢复正常。随访一年,对照组有4例复发,线性消融组无复发,具有统计学差异(P<0.05)。
结论:采取Koch三角基底部线性消融改良房室结双径路是提高射频消融治AVNRT成功率的一种安全有效的方法,可作为常规消融法的补充术式。
Objective: To investigate the atrioventricular nodal reentrant tachycardia conventional method of residual slow pathway after ablation linear approach in the Koch’s triangle changes in electrophysiological properties and clinical efficacy.
Methods: 160 patients with AVNRT after successful ablation by conventional methods after the 49 patients with residual slow pathway were randomly allocated to the linear ablation group (n=25) and control group (n=24). Electrophysiology ablation were recorded before the two remaining slow pathway effective refractory period (ERP) and the maximum AH interval (A-Hmax), residual slow pathway ablation group blocking rate, such as failure to stop residual slow pathway Off the record, the average ERP of slow pathway, and A-Hmax changes as well as follow-up period without recurrence of tachycardia.
Results: In control group mean slow pathway effective refractory period was 288.6±56.0ms, average maximum A-H interval was 306.9±52.0ms. Additional linear ablation group before ablation of slow pathway effective refractory period of the average 279±45.0ms, average maximum A-H interval was 312.9±66.8ms, the parameters of the two groups before surgery was no significant difference (P >0.05). Additional linear ablation group, 15 patients after ablation of slow pathway blocked, not blocked an average of 10 cases of slow pathway effective refractory period increased to 310.6±67.0ms, average maximum AH interval shortened to 280.9±52.0ms, with the control group Statistically significant difference compared (P <0.05). Intraoperative linear ablation group 1 patient had transientⅢ。AVB, stop the discharge back to normal. Follow-up year, the control group and the linear ablation group were 4 cases and 0 case of relapse, with a significant difference (P <0.05).
Conclusion: Adopt linear approach in the Koch’s triangle improved the treatment of dual atrioventricular node pathways AVNRT in a safe and effective method can be used as supplementary conventional surgical ablation.
方法:160例AVNRT经常规方法消融成功后残存慢径患者49例,随机分为线性消融组(25例)和对照组(24例)。电生理检查分别记录线性消融前两组残存慢径路有效不应期(ERP)以及最大AH间期(A-Hmax),线性消融组残存慢径阻断率(如经线性消融残存慢径未能阻断则记录慢径路的ERP和A-Hmax的改变情况)以及两组复发情况。
结果:对照组残存慢径路平均ERP为288.6±56.0ms,平均A-Hmax306.9±52.0 ms。线性消融组补充消融前慢径路平均ERP为279±45.0ms,平均A-Hmax为312.9±66.8ms,两组术前各项参数比较无统计学差异(P>0.05)。线性消融组补充消融后15例慢径路阻断,未能阻断的10例慢径路平均ERP增加至310.6±67.0 ms,平均A-Hmax缩短为280.9±52.0ms,跟对照组比较差异具有统计学意义(P<0.05)。线性消融组术中1例出现一过性Ⅲ。AVB,停止放电后恢复正常。随访一年,对照组有4例复发,线性消融组无复发,具有统计学差异(P<0.05)。
结论:采取Koch三角基底部线性消融改良房室结双径路是提高射频消融治AVNRT成功率的一种安全有效的方法,可作为常规消融法的补充术式。
Objective: To investigate the atrioventricular nodal reentrant tachycardia conventional method of residual slow pathway after ablation linear approach in the Koch’s triangle changes in electrophysiological properties and clinical efficacy.
Methods: 160 patients with AVNRT after successful ablation by conventional methods after the 49 patients with residual slow pathway were randomly allocated to the linear ablation group (n=25) and control group (n=24). Electrophysiology ablation were recorded before the two remaining slow pathway effective refractory period (ERP) and the maximum AH interval (A-Hmax), residual slow pathway ablation group blocking rate, such as failure to stop residual slow pathway Off the record, the average ERP of slow pathway, and A-Hmax changes as well as follow-up period without recurrence of tachycardia.
Results: In control group mean slow pathway effective refractory period was 288.6±56.0ms, average maximum A-H interval was 306.9±52.0ms. Additional linear ablation group before ablation of slow pathway effective refractory period of the average 279±45.0ms, average maximum A-H interval was 312.9±66.8ms, the parameters of the two groups before surgery was no significant difference (P >0.05). Additional linear ablation group, 15 patients after ablation of slow pathway blocked, not blocked an average of 10 cases of slow pathway effective refractory period increased to 310.6±67.0ms, average maximum AH interval shortened to 280.9±52.0ms, with the control group Statistically significant difference compared (P <0.05). Intraoperative linear ablation group 1 patient had transientⅢ。AVB, stop the discharge back to normal. Follow-up year, the control group and the linear ablation group were 4 cases and 0 case of relapse, with a significant difference (P <0.05).
Conclusion: Adopt linear approach in the Koch’s triangle improved the treatment of dual atrioventricular node pathways AVNRT in a safe and effective method can be used as supplementary conventional surgical ablation.
引文
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