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目的分析总结经导管射频消融治疗快速型心律失常的疗效,以进一步指导相关临床工作。方法回顾性分析951例(男532例,女419例)经导管射频消融治疗快速型心律失常患者的治疗结果,患者年龄6~78(42.5±14.6)岁,心动过速发作史1个月~42年,采用常规方法进行电生理检查和射频消融。结果房室折返性心动过速(AVRT)569例,计有旁道578条,其中左侧旁道患者462例(分布位置:左游离壁364例,左前壁41例,左后侧壁57例),右侧旁道79例,双旁道9例(右侧6例,左侧3例),房室结双径路合并房室旁道19例(右侧5例,左侧14例)。房室结折返性心动过速(AVNRT)341例,其中260例存在前向跳跃式传导,16例存在逆向跳跃式传导,65例无跳跃式传导。室性心动过速(VT)19例,房性心动过速(AT)22例。射频消融总成功率为97.9%,其中房室结双径路和左侧房室旁道介导的阵发性室上速射频消融成功率高达99.5%。射频消融术后复发率为1.7%。8例术中出现一过性房室传导阻滞,后有2例发生Ⅰ度房室传导阻滞,1例交替出现Ⅰ、Ⅱ、Ⅲ度房室传导阻滞,1例发生Ⅲ度房室传导阻滞后置入永久性心脏起搏器;术后12例发生假性动脉瘤,1例气胸和1例心包填塞。结论经导管射频消融是治疗快速型心律失常安全有效的方法,尤以AVRT和AVNRT的效果最佳。
Objective To summarize the curative effect of transcatheter radiofrequency ablation of tachyarrhythmia to further guide the clinical work. Methods A total of 951 patients (532 males and 419 females) undergoing catheter ablation of radiofrequency ablation were retrospectively analyzed. The patients were aged from 6 to 78 years (42.5 ± 14.6 years) and had a history of tachycardia within 1 month ~ For 42 years, electrophysiological examination and radiofrequency ablation were performed using conventional methods. Results A total of 569 cases of atrioventricular reentrant tachycardia (AVRT) were scheduled. There were 578 cases of bypass, of which 462 cases were located in the left side of the bypass (364 cases of left free wall, 41 cases of left anterior wall, 57 cases of left posterior wall ), 79 cases of the right bypass, 9 cases of the double bypass (6 cases on the right, 3 cases on the left), 19 cases (5 on the right and 14 on the left) . Atrioventricular nodal reentrant tachycardia (AVNRT) 341 cases, of which 260 cases of anterior leaping conduction exists, 16 cases of reverse leaping conduction, 65 cases without leaping conduction. 19 cases had ventricular tachycardia (VT) and 22 cases had atrial tachycardia (AT). The success rate of radiofrequency ablation was 97.9%. The successful rate of radiofrequency ablation of paroxysmal supraventricular tachycardia mediated by AVN and left atrioventricular bypass was as high as 99.5%. The recurrence rate after radiofrequency ablation was 1.7%. In 8 cases, there was a transient atrioventricular block, followed by 2 cases with Ⅰ degree AV block, 1 case with Ⅰ, Ⅱ, Ⅲ degree atrioventricular block and 1 case with Ⅲ degree atrioventricular block After the conduction block, a permanent pacemaker was placed; in 12 cases, pseudoaneurysm, 1 pneumothorax and 1 cardiac tamponade occurred. Conclusions Transcatheter radiofrequency ablation is a safe and effective method for the treatment of tachyarrhythmias, especially AVRT and AVNRT.