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  [摘要] 目的:探讨间隔部房室旁道射频消融术发生房室传导阻滞的原因。方法:回顾分析67例间隔部旁路参与的房室折返性心动过速患者射频消融的临床资料。结果:消融成功率为98.5%(66/67),3例发生Ⅱ度至Ⅲ度房室传导阻滞,发生率为4.55%(3/66)。结论:虽然房室旁路的消融手术成功率高、操作安全,但间隔部旁路消融仍具有挑战性。熟练的心电生理和解剖知识、精确标测、低功率放电、增加消融电极稳定性,有助于减少房室传导阻滞的发生。

 [关键词] 射频导管消融; 间隔部旁路； 房室传导阻滞

 [中图分类号] R541.76 [文献标识码] A [文章编号] 1671-7256(2011)02-0146-03

 doi：10.3969/j.issn.1671-7256.2011.02.007

 Retrospective analysis of atrioventricular block triggered by radiofrequency

 ablation in the treatment of septal accessory pathway

 REN Yin, ZHU Li, RUAN Zhong-bao, YIN Yi-gang, CHEN Ge-cai, CHEN Ming,ZHANG Yi-sheng, XU Hong, JIN Mei

 (Department of Cardiology, Peoples Hospital of Taizhou, Taizhou 225300, China)

 [Abstract] Objective: To investigate the cause of atrioventricular block(AVB) triggered by radiofrequency ablation(RFCA) in the treatment of septal accessory pathway. Methods: We retrospectively analyzed the clinic features of patients who were cured by RFCA with septal accessory pathway. Results: The success rate for ablation of septal accessory pathway was 98.5%(66/67). AVB occurred in 3 of 66 patients(4.55%) of second-degree block to third-degree block. Conclusion: Although ablation of accessory bypass tracts is a successful and safe procedure, septal pathways bypass remains challenging. Accurate knowledge of cardiac electrophysiology and anatomy involved, precise mapping, lower ablation energy, enhanced catheter stability may reduce AVB.

 [Key words] radiofrequency catheter ablation; septal accessory pathway; atrioventricular block

 房室传导阻滞(atrioventricular block, AVB)是射频消融(radiofrequency catheter ablation, RFCA)治疗阵发性室上性心动过速(paroxysmal paroxysmal supraventricular tachycardia, PSVT)的严重并发症,尤其在房室结双径路改良和间隔部旁路消融时常见。如何避免AVB是手术成功的关键之一。我们回顾性分析67例在我院行射频消融治疗间隔部旁路患者的临床资料及随访结果,以探讨引起AVB的原因,并为避免发生AVB提供借鉴。

 1 资料与方法

 1.1 一般资料

 2001年11月至2010年8月间采用射频导管消融治疗间隔部旁路参与的房室折返性心动过速(atrioventricular reentrant tachycardia,AVRT)共67例,其中男43例,女24例；年龄8～74岁,平均年龄(42.0±11.7)岁；病程3个月～36年；合并冠心病7例,高血压11例。

 1.2 方法

 常规穿刺左锁骨下静脉、右侧股静脉,标测电极导管分别置于冠状静脉窦、右心室、高位右心房,希氏束电位以高位右心房电极标测出希氏束后影像定位作为参照,行腔内电生理检查,标测、消融及消融成功标准参见《射频导管消融治疗快速心律失常指南》[1]。

 1.3 随访

 对发生房室传导阻滞的患者进行长期随访：每月行心电图检查,每3～6个月行24 h动态心电图检查。

 2 结 果

 2.1 旁道部位分布

 经术中电生理检查证实,67例间隔部旁道具体分布如下:右前间隔旁道13例,其中显性旁道9例,隐匿性旁但4例;右中间隔旁道7例,其中显性旁道5例,隐匿性旁道2例;右后间隔旁道17例,其中显性旁道10例,隐匿性旁道7例;左后间隔旁道30例,其中显性旁道10例,隐匿性旁道20例。

 2.2 消融成功率

 67例间隔部旁道中66例(98.5%)消融成功,1例放弃手术(右中间隔旁路)。

 2.3 术中并发AVB

 共3例患者术中并发房室传导阻滞,发生率为4 ......