经导管射频消融治疗阵发性室上性心动过速1106例临床分析

目的探讨经导管射频消融治疗阵发性室上性心动过速的效果及安全性。方法2003年7月至2011年1月在厦门市心脏中心行心内电生理检查及射频消融术治疗的心动过速患者1106例,分析各型心动过速的构成比,评价术中成功率及其相关因素,长期随访观察复发率及并发症发生率。结果共纳入阵发性室上性心动过速患者1106例,男女比例为1：1,其中房室旁道型心动过速588例,房室结折返型心动过速477例,房性心动过速41例。术中即刻消融成功1087例（98．3％,1087／1106）,复发43例（3．9％,43／1106）,其中房室结折返型心动过速复发7例（1．5％,7／477）;房室旁道复发33例（5．6％,33／588）,左侧旁道复发16例（3．9％,16／302）,右侧旁道17例（9．1％,17／186）;房性心动过速复发3例（8．1％,3／41）。并发症发生率为1．5％（17／1106）,主要为气胸6例,血气胸1例,肺栓塞1例,左颈皮下气肿1例,术中一过性Ⅲ度房室传导阻滞2例,术中I度房室传导阻滞3例,术后持续性Ⅲ度房室传导阻滞需植入永久性心脏起搏器2例（0．2％）,术后5d心源性猝死1例,为长期中风卧床者,为手术非相关死亡。结论经导管射频消融为阵发性室上性心动过速安全有效的治疗方法。     

阵发性室上性心动过速的射频消融治疗

[目的]探讨射频消融术（RFCA）治疗阵发性室上性心动过速（PSVT）的安全性和成功率。【方法】回顾分析RFCA治疗PSVT101例的疗效；101例中包括房室间折返性心动过速（AVRT）48例，左侧旁道38例，右侧旁道10例，房室结折返性心动过速（AVNRT）53例。均先行心内电生理检查确定心动过速类型和消融靶点。【结果】总成功率100％（101／101例），总复发率0．99％（1／101例），再次RFCA获得成功。2例发生Ⅲ度房室传导阻滞，发生率1．98％（2／101），1例发生左侧气胸（左上肺受压约30％）于RFCA术后一周自然吸收，发生率o．99％（1／101）。【结论】根据设备条件严格掌握适应证，消融前进行系统电生理检查，旁道消融靶点正确标测，放电中Ⅲ度房室传导阻滞的识别和消融终点正确判定是提高安全性和成功率的关键。     

异丙肾上腺素评价房室结改良术终点18例分析

射频消融术在国内外已成为多种快速心律失常有效的介入性治疗方法。亦是治疗房室结折返性心动过速（AVNRT）非常有效的方法。目前消融慢径成为治疗AVNRT的常规方法，其成功率达95％以上。我院自1994年5月～1998年1月对58例患者进行了射频消融术，其中18例AVNRT患者采用了房室结改良术，取得了良好的治疗效果。1资料与方法1．1一般资料：18例中，男6例，女12例，年龄32～70岁（平均41．4士16．6岁），均有1年以上的室上速反复发作史，经检查无其它器质性心脏病。1．2标测与消融方法；所有病人停用抗心律失常药物5个半衰期以上，不用镇…     

经导管射频消融治疗房室结折返性心动过速

采用射频消融术（ＲＦＣＡ）对１２例房室结双径路患者进行了房室改良术，成功率１００％，平均放电功率２０～３５Ｗ（３０±４．５Ｗ），平均放电时间２０～２４０ｓ（１２０±５２ｓ），平均放电次数２～７次（８±５次），病人随访６个月以上，无１例复发。结果表明射频消融术治疗房室结折返性心动过速是安全、有效的方法。     

射频消融室房传导用于VVI起搏二例报告

自1991年国内开展射频（RF）消融术治疗心律失常以来，各在多用于治疗房室结双径路及予激综合征房室附加旁道所致的房室结折返及房室折返性心动过速，该科于93年3月开始上述治疗，并于同年5月始用RF消融术对两例病窦慢快综合征患者在植入及更换VVI起搏器时进行了房室交界区肖融，消除了室房（V-A）起导，纠正了阵发性快速房律失常，使植入的VVI起搏得以保留并发挥良好效果，现报告如下。     

导管射频消融治疗快速型心律失常470例临床分析

【目的】探讨经导管射频消融（RFCA）治疗快速心律失常的有效性和安全性及不同年龄阶段患者的临床特点及对RFCA的影响。【方法】对470例各种快速型心律失常不同年龄阶段患者的临床特点及疗效进行对比分析。其中房速（AT）22例；房扑（AF）8例；房室折返性心动过速（AVRT）280例，其中右侧旁道（RAP）228例，左侧旁道（I，AP）52例；房室结折返性心动过速（AVNTR）136例；特发性室速（IVT）32例。对不同年龄阶段患者的临床特点及疗效进行对比分析。【结果】总体消融成功率为95．3％，并发症发生率6．8％。在年龄分组比较中RFCA治疗功率相似，但老年与儿童及青少年并发症比较高。【结论】导管射频消融可以作为治疗快速型心律失常的首选方法，治疗成功率高，复发率低，但应警惕其并发症发生，尤其是儿童与老年人。     

经皮室间隔心肌化学消融术（PTSMA）治疗肥厚型梗阻性心肌病（HOCM）20例疗效分析

目的评价经皮室间隔心肌化学消融术（PTSMA）治疗肥厚型梗阻性心肌病（HOCM）的近期疗效。方法2004年8月至2007年8月超声心动图诊断HOCM20例患者行PTSMA,并在消融术前及术后2周分别行超声心动图检查,测量患者室间隔厚度、左室流出道宽度以及左室流出道压力阶差（LVOTPG）。结果术前平均LVOTPG为（75．48）mmHg,术中球囊加压后平均压力阶差为（27．64）mmHg,IVS消融术后为（28．54）mmHg,较术前下降50％～75％,与消融前比差异有统计学意义（P〈0．001）。消融术前IVS厚度（21．9±3．2）min,术后两周（18．58±5．1）mm,消融术前平均LVOT宽度（5．7±2．3）mm,术后2周（10．7±3．3）mm。术中发现9例患者发生一过性房室传导阻滞（AVB）。Ⅰ度AVB5例（25％）,Ⅱ度AVB3例（15％）,术中发生一过性完全右束支阻滞2例（10％）,一过性窦性心动过缓14例（70％）,一过性交界性心律5例（25％）,室性过早搏动7例（35％）,室性心动过速3例（15％）。结论PTSMA能显著降低室间隔厚度,增加左室流出道的宽度,降低左室与流出道压力阶差（LVDTG）。无严重心律失常并发症发生。证明PTSMA是治疗HOCM的有效方法,其近期疗效可靠。     

65例阵发性室上性心动过速射频消融术后的护理

自１９９３年１１月至１９９６年８月对６５例阵发性室上性心动过速（ＰＳＶＴ）患者进行射频消融术，其中男３２例，女３３例，１０～６６岁，平均３９±１３岁，左侧显性旁道１７例，隐性旁道１８例，右侧显性旁道８例，隐性旁道９例，房室结内双径路１２例，自律性房性心动过速（ＡＡＴ）１例。术后经精心护理，及时发现和处理并发症，所有患者均治愈出院     

显性房室旁道对心室除极波终末向量变化的影响

目的 探讨显性房室旁道对心室除极波终末向量的影响.方法选择经射频消融(RFCA)术证实的显性单房室旁道102例及隐匿性单房室旁道38例患者,经临床常规检查元器质性心脏病.将房室旁道分为后间隔(PS)、中间隔(MS)、前间隔(AS)、左后游离壁(LP)、左前游离壁(LA)、右后游离壁(RP)及右前游离壁(RA)房室旁路.结果102例显性房室旁道患者射频消融术后终末向量全部发生改变,38例隐匿性房室旁道中的4例射频消融术后终末向量发生改变,34例无变化.显性房室旁路与隐匿性房室旁路相比差异有统计学意义(P<0.05).不同部位间的显性旁路相比差异无统计学意义(P>0.05);终末向量的变化具有导联特异性.结论显性房室旁道可以改变心室除极终末向量,并且这种变化具有导联的特异性.     

房室结加速传导对房室折返性心动过速的影响

目的：探讨房室结加速传导（ＥＡＶＮＣ）对顺向型房室折返性心动过速（ＯＡＶＲＴ）的影响,方法：对２７例具有突发突止心视患者作食管心房调峰（ＴＥＡＰ）检查及对６例左侧旁道患者进行射频消融术。结果：发现具有ＥＡＶＮＣ９例与ＥＡＶＮＣ９例比较,文氏点,ＳＲ延长值,ＯＡＶＲＴ的周期,房颤时心室率,最短ＲＲ间期差异有显著意义Ｐ〈．０５）,对６例左侧旁道患者进行射消融术,结果发现ＥＡＶＮＣ患者房室结－希浦系前传     

Radiofrequency Catheter Ablation of a Concealed Accessory Atrioventricular Pathway After Heart Transplantation

Three months after orthotopic cardiac transplantation, a 46-year-old man developed paroxysmal supraventricular tachycardia. Electrophysiological investigation of the arrhythmia led to the diagnosis of an atrioventricular reentrant tachycardia involving a left lateral concealed accessory pathway. When antiarrhythmic drugs failed to suppress the arrhythmia, radiofrequency catheter ablation of the accessory pathway was performed without complication.     

Radiofrequency Catheter Ablation of Accessory Pathways During Entrainment of AV Reentrant Tachycardia

Radiofrequency ablation of accessory pathways must sometimes be done during orthodromic atrioventricular reentrant tachycardia when manifest anterograde accessory pathway conduction is absent or retrograde fusion obscures accessory pathway location during ventricular pacing. Unfortunately, abrupt heart rate slowing upon radiofrequency induced termination of atrioventricular reentrant tachycardia often causes catheter dislodgment. We report our experience in circumventing this problem during radiofrequency ablation by using entrainment of atrioventricular reentrant tachycardia. The latter maintains retrograde activation pattern over the accessory pathway while preventing abrupt ventricular rate change. Eight patients (4 men and 4 women, mean age 37.3 ± 17.9) with eleven left-sided accessory pathways were included. Ablation during entrainment was used as the first approach in three patients with concealed accessory pathways and one patient with a bidirectional accessory pathway. In another four patients, ablation during entrainment was used after technical difficulties in ablating during tachycardia. Only 1–3 radiofrequency applications were required to eliminate the accessory pathway using the entrainment technique. The catheter remained stable when accessory pathway conduction was interrupted by radiofrequency current. In conclusion, entrainment of atrioventricular reentrant tachycardia during radiofrequency application is useful for maintaining catheter position for accessory pathway ablation during atrioventricular reentrant tachycardia.     

Electrophysiologic characteristics and radiofrequency catheter ablation in children with Wolff-Parkinson-White syndrome

BACKGROUND: The majority of cardiac arrhythmias in children are supraventricular tachycardia, which is mainly related to an accessory pathway (AP)-mediated reentry mechanism. The investigation for Wolff-Parkinson-White (WPW) syndrome in adults is numerous, but there is only limited information for children. This study was designed to evaluate the specific electrophysiologic characteristics and the outcome of radiofrequency (RF) catheter ablation in children with WPW syndrome. METHODS: From December 1989 to August 2005, a total of 142 children and 1,219 adults with atrioventricular reentrant tachycardia (AVRT) who underwent ablation at our institution were included. We compared the clinical and electrophysiologic characteristics between children and adults with WPW syndrome. RESULTS: The incidence of intermittent WPW syndrome was higher in children (7% vs 3%, P=0.025). There was a higher occurrence of rapid atrial pacing needed to induce tachycardia in children (67% vs 53%, P=0.02). However, atrial fibrillation (AF) occurred more commonly in adult patients (28% vs 16%, P=0.003). The pediatric patients had a higher incidence of multiple pathways (5% vs 1%, P<0.001).Both the onset and duration of symptoms were significantly shorter in the pediatric patients. The antegrade 1:1 AP conduction pacing cycle length (CL) and antegrade AP effective refractory period (ERP) in children were much shorter than those in adults with manifest WPW syndrome. Furthermore, the retrograde 1:1 AP conduction pacing CL and retrograde AP ERP in children were also shorter than those in adults. The antegrade 1:1 atrioventricular (AV) node conduction pacing CL, AV nodal ERP, and the CL of the tachycardia were all shorter in the pediatric patients. CONCLUSION: This study demonstrated the difference in the electrophysiologic characteristics of APs and the AV node between pediatric and adult patients. RF catheter ablation was a safe and effective method to manage children with WPW syndrome.     

Catheter Ablation for Recurrent Tachyarrhythmias. Clinical Experience with Two Different Techniques of Ablation in 21 Patients

Between 1984 and 1988, 21 patients underwent catheter ablation for drug refractory arrhythmias. Nine patients presented atrial flutter, atrial fibrillation or atrial tachycardia, nine had supraventricular tachycardia (one AV nodal reentrant tachycardia, one reciprocating tachycardia due to concealed accessory pathway and seven XMPW syndrome). Three had ventricular tachycardia. Fourteen patients were treated with direct current shock ablation (DC) and seven patients with radiofrequency ablation (RF). Eight patients underwent ablation of the His bundle. In six patients permanent AV block could be induced and in two first-degree AV block. All became asymptomatic (two with additional antiarrhythmic drug therapy). In four patients with WPW syndrome DC ablation of the accessory pathway was attempted. In one patient a permanent block in the accessory pathway and in another an intermittent block were obtained. In the two remaining patients with accessory pathways the ablation failed to interrupt the retrograde conduction in one the retrograde conduction was modified: however, in the other no change could be demonstrated. Two patients underwent ventricular foci ablation, with one partial success (arrhythmia controlled with associated drug therapy) and one failure. Three patients had RF His bundle ablation (two for atrial flutter and one for atrial fibrillation). One complete atrioventricular block, one first degree AV block and one first degree AV block associated with right bundle branch block were induced. Recurrence of tachyarrhythmias was prevented only in the patient with complete atrioventricular block. RF ablation of accessory pathway was performed in three patients. It resulted in anterograde block in the accessory pathway in the first patient; a slight modification of the retrograde refractory period in the second and no change was noted in the last one. The first of these three patients could then be controlled with drug therapy. The other two patients underwent surgical dissection of the pathway. One patient underwent an unsuccessful attempt of ventricular focus ablation with RF energy. Complications were more common with DC than with RF ablation but serious ventricular arrhythmias were also observed during RF ablation. Thus, DC ablation was completely successful in eight of 14 patients (57%), partially successful with the addition of drug therapy in three patients (21%) and failed in 22%. HF ablation was successful in only one patient (14.5%) and partially successful in another one (14.5%). This relatively low success rate is due in part to the design of the device and the electrodes used in this study. With technical improvements of RF ablation it seems reasonable to expect that this method will play a significant role in the management of drug refractory arrhythmias, since RF ablation, when compared to DC ablation, has the major advantage not to require general anesthesia during the procedure.     

Radiofrequency Catheter Ablation of an Accessory Pathway in a Young Man with Dextroversion

We report an observation of a radiofrequency catheter ablation of an accessory pathway (AP) in a patient with Wolff-Parkinson-White syndrome (WPW) and dextroversion. Atrioventricular rings were mapped by the ablation catheter to locate the shortest local atrioventricular conduction time in sinus rhythm and ventriculoatrial conduction time during orthodromic tachycardia or ventricular pacing. Successful ablation confirmed a right posteroseptal AP localization. Thus, the electrocardiographic modifications due to an AP in this location in the presence of dextroversion were defined.     

Recurrence of symptomatic atrial fibrillation after successful catheter ablation of atrioventricular accessory pathways: a multivariate regression analysis

The primary aim of this study is to investigate the factors related to the recurrence of atrial fibrillation (AF) after a successful ablation of atrioventricular accessory pathway. Thirty-seven patients with spontaneous AF (study group) were selected from 401 consecutive patients who underwent radiofrequency catheter ablation of atrioventricular accessory pathway. A multivariate regression analysis was used in order to evaluate the relationships between AF recurrence and patients' age, sex, atrial size, left ventricular function, location of accessory pathways, heart rate during atrioventricular re-entrant tachycardia and atrial vulnerability (induction of sustained AF) after a successful ablation. Atrioventricular accessory pathway was abolished in 36 of the study group patients and 351 of the control group patients. During the follow-up of 36 +/- 11 months, four patients (11.1%) from the study group experienced sustained AF. Multivariate regression analysis showed that, in patients with pre-ablation AF, older age and post-ablation atrial vulnerability were the only independent predictive factors for AF recurrence. We concluded that radiofrequency catheter ablation of atrioventricular accessory pathway greatly reduces the risk of AF in patients who had a history of symptomatic AF. Older patients and patients with inducible AF after accessory pathway ablation are at an increased risk of AF recurrence. These patients should be closely monitored after successful ablation of atrioventricular accessory pathways.     

Successful stenting of a left main coronary artery occlusion as a complication of RF ablation for Wolff-Parkinson-White syndrome

Wolff-Parkinson-White (WPW) syndrome is a disorder characterized by presence of an accessory pathway that predisposes patients to tachyarrhythmias and sudden death. Radiofrequency ablation (RFA) is both effective and safe for patients with symptomatic tachyarrhythmias mediated by accessory atrioventricular pathways. During the procedure, fatal complications may occur but it is considered low in relation to the morbidity associated with the WPW syndrome. Coronary artery occlusion, as a complication of an RF catheter ablation, is quite rare. In this report, we present a 56-year-old male patient with a left main coronary artery (LMCA) occlusion during the ablation of left anterolateral wall accessory pathway. It should be kept in mind if the patient complains of new onset of severe chest pain, an immediate angiography should be performed.     

Use of Adenosine to Identify Patients at Risk for Recurrence of Accessory Pathway Conduction After Initially Successful Radiofrequency Catheter Ablation

Objectives: The use of adenosine after radiofrequency catheter ablation of accessory pathways was prospectively studied to determine its utility for identifying patients at risk for recurrence of accessory pathway conduction and to guide therapy that might reduce late recurrence in this group. Background: Accessory pathway conduction recursin 5%–12% of patients following initially "successful" radiofrequency catheter ablation. Adenosine may facilitate conduction over accessory pathways that have been modified by radiofrequency delivery, thus identifying patients at risk for recurrence. Methods: Radiofrequency catheter ablation was performed in 109 patients. Prior to ablation, 12–18 mg of adenosine was administered. After ablation, when all evidence of accessory pathway conduction remained absent for at least 30 minutes, adenosine 12–18 mg was again administered. Results: Adenosine given prior to radiofrequency catheter ablation did not block accessory pathway conduction in any patient. Adenosine given after elimination of accessory pathway conduction induced complete atrioventricular and ventriculoatrial block in 95 patients; 11 (11.6%) subsequently had recurrence of accessory pathway function. Accessory pathway conduction was unmasked by adenosine in 12 patients (11.2%). After further deliveries of radiofrequency energy, 7 of these 12 patients subsequently demonstrated adenosine induced atrioventricular and ventriculoatrial block; 1 of these 7 patients experienced recurrence of accessory pathway conduction. The remaining 5 patients demonstrated persistent accessory pathway conduction only with adenosine; all experienced clinical recurrence of accessory pathway function. Conclusion: The use of adenosine after presumed successful radiofrequency catheter ablation may reveal persistent accessory pathway conduction. Elimination of this latent accessory pathway conduction reduces the risk for recurrence.     

The use of echocardiography in Wolff–Parkinson–White syndrome

Endocardial mapping and radiofrequency catheter ablation are well established modalities for the diagnosis and treatment of patients with Wolff–Parkinson–White (WPW) syndrome associated with tachyarrhythmias. However, the electrophysiologic techniques are invasive, require radiation exposure, and lack spatial resolution of cardiac structures. A variety of echocardiographic techniques have been investigated as a non-invasive alternative for accessory pathway localization. Conventional M-mode echocardiography can detect the fine premature wall motion abnormalities associated with WPW syndrome. However, it is unable to identify the exact site of accessory pathway with sufficient accuracy. 2D, 2D-guided M-mode, and 2D phase analysis techniques are limited by image quality and endocardial border definition. Various modalities of tissue Doppler echocardiography significantly increase the accuracy of left-sided accessory pathway localization to 80–90% even in patients with poor acoustic window. However, right-sided pathways remain a diagnostic challenge. Strain echocardiography by speckle tracking has recently been evaluated and appears promising. Different cardiac abnormalities have been detected by echocardiography in WPW patients. Patients with WPW syndrome and tachyarrhythmias have impaired systolic and diastolic function which improves after radiofrequency ablation. Echocardiography is useful in identifying patient with accessory pathway-associated left ventricular dyssynchrony and dysfunction who may benefit from ablation therapy. Transesophageal and intracardiac echocardiography have been used to guide ablation procedure. Ablation-related complications detected by routine echocardiography are infrequent, rarely clinically relevant, and of limited value.