射频导管消融右心房后位峡部和间隔峡部治疗典型心房扑动方法的对比研究(摘要)
作者：马坚 王方正 余培桢 王锦志 张奎俊 华伟 楚建民 张澍 陈新 孙瑞龙
单位：北京市，中国医学科学院 中国协和医科大学 心血管病研究所 阜外心血管病医院 临床电生理研究室(100037)
关键词：
中国循环杂志99zk111 目的：分别对35例典型心房扑动患者的后位峡部(下腔静脉—三尖瓣环峡部)或间隔峡部(欧氏嵴—三尖瓣环之间)进行线性消融，对比两种消融方法的疗效。
方法：35例患者，男性30例，女性5例。平均年龄：53±15岁。心房扑动病史6个月～11年。按消融方法随机分组：后位峡部组15例，间隔峡部组20例。心房扑动心律或持续冠状静脉窦口起搏(窦性心律者)下，4 mm或8 mm消融电极导管线性消融后位峡部或间隔峡部。如果同一方法反复消融8次以上未成功者，则改用另一方法(另一峡部或线径)进行消融。成功消融终点为心房扑动不能诱发和峡部完全性双向阻滞。
, http://www.100md.com
结果：术中心房扑动心律者，后位峡部组10例，间隔峡部组15例，心房扑动周长分别为240±30 ms和220±23 ms(P>0.05)。窦性心律者，两组各5例。35例患者均消融成功，未发生并发症。两组各有2例患者在首选方法消融失败后，改用另一消融方法获得成功。比较首选方法消融成功者的手术时间、X线透视时间和放电次数，两组均无显著性差异。平均随访10.4±3.8个月。1例后位峡部消融成功者的心房扑动复发。
结论：本文随机对比了后位峡部和间隔峡部消融的两种方法，结果显示两者的消融成功率相近，放电次数和手术时间均无显著性差异；而且对一种消融方法失败的2例患者，变更为另一方法后均获成功，表明两种方法可以相互替补，提高了消融治疗的成功率。笔者体会一般情况下两种消融方法均安全有效，可根据术者的经验而选用。
Radiofrequency Catheter Ablation of Typical Atrial Flutter: Comparison of Posterior Isthmus Ablation and Septal Isthmus Ablation Technique (Abstract)
, http://www.100md.com
Department of Clinical Electrophysiology, Cardiovascular Institute and Fu Wai Hospital, CAMS and PUMC, Beijing (100037)
Ma Jian, Wang Fangzheng, Yu Peizhen, et al.
Objective: To compare posterior isthmus (inferior vena cava-tricuspid annulus isthmus) ablation technique and septal isthmus (tricuspid annulus-Eustachian ridge isthmus) ablation technique for typical atrial flutter.
Methods: Thirty-five patients (mean age 53±15 years) with typical atrial flutter were randomly assigned to undergo radiofrequency catheter ablation performed with posterior isthmus ablation technique (PI group, 15 patients) or septal isthmus ablation technique (SI group, 20 patients). Radiofrequency energy was used to create linear lesion from tricuspid ring to inferior vena cava in the PI group and from tricuspid ring to Eustachian ridge in the SI group. The ablation technique was changed to the other, if one of the ablation techniques failed to block the isthmus after eight applications of radiofrequency energy. The endpoint of successful ablation included a complete bidirectional conduction block at isthmus and inability to induce atrial flutter.
, http://www.100md.com
Results: Atrial flutter was present at the onset of ablation in 10 patients of the PI group and in 15 patients of the SI group, however the cycle lengths of atrial flutter between the two groups were 240±30 ms and 220±23 ms (p<0.05), respectively. The endpoint of successful ablation was achieved in all of the patients without any complication. The ablation technique was changed for two patients in both groups after the primary ablation technique was unsuccessful. The times of radiofrequency application and procedure time were not significantly different in both groups. During a mean follow-up of 15.4±3.8 months, one patient (PI group) experienced atrial flutter recurrence.
Conclusion: Radiofrequency ablation of typical atrial flutter is safe and effective with either the posterior isthmus ablation technique or the septal isthmus ablation technique. The ablation success rate can be increased when these two techniques are used alternatively., 百拇医药
单位：北京市，中国医学科学院 中国协和医科大学 心血管病研究所 阜外心血管病医院 临床电生理研究室(100037)
关键词：
中国循环杂志99zk111 目的：分别对35例典型心房扑动患者的后位峡部(下腔静脉—三尖瓣环峡部)或间隔峡部(欧氏嵴—三尖瓣环之间)进行线性消融，对比两种消融方法的疗效。
方法：35例患者，男性30例，女性5例。平均年龄：53±15岁。心房扑动病史6个月～11年。按消融方法随机分组：后位峡部组15例，间隔峡部组20例。心房扑动心律或持续冠状静脉窦口起搏(窦性心律者)下，4 mm或8 mm消融电极导管线性消融后位峡部或间隔峡部。如果同一方法反复消融8次以上未成功者，则改用另一方法(另一峡部或线径)进行消融。成功消融终点为心房扑动不能诱发和峡部完全性双向阻滞。
, http://www.100md.com
结果：术中心房扑动心律者，后位峡部组10例，间隔峡部组15例，心房扑动周长分别为240±30 ms和220±23 ms(P>0.05)。窦性心律者，两组各5例。35例患者均消融成功，未发生并发症。两组各有2例患者在首选方法消融失败后，改用另一消融方法获得成功。比较首选方法消融成功者的手术时间、X线透视时间和放电次数，两组均无显著性差异。平均随访10.4±3.8个月。1例后位峡部消融成功者的心房扑动复发。
结论：本文随机对比了后位峡部和间隔峡部消融的两种方法，结果显示两者的消融成功率相近，放电次数和手术时间均无显著性差异；而且对一种消融方法失败的2例患者，变更为另一方法后均获成功，表明两种方法可以相互替补，提高了消融治疗的成功率。笔者体会一般情况下两种消融方法均安全有效，可根据术者的经验而选用。
Radiofrequency Catheter Ablation of Typical Atrial Flutter: Comparison of Posterior Isthmus Ablation and Septal Isthmus Ablation Technique (Abstract)
, http://www.100md.com
Department of Clinical Electrophysiology, Cardiovascular Institute and Fu Wai Hospital, CAMS and PUMC, Beijing (100037)
Ma Jian, Wang Fangzheng, Yu Peizhen, et al.
Objective: To compare posterior isthmus (inferior vena cava-tricuspid annulus isthmus) ablation technique and septal isthmus (tricuspid annulus-Eustachian ridge isthmus) ablation technique for typical atrial flutter.
Methods: Thirty-five patients (mean age 53±15 years) with typical atrial flutter were randomly assigned to undergo radiofrequency catheter ablation performed with posterior isthmus ablation technique (PI group, 15 patients) or septal isthmus ablation technique (SI group, 20 patients). Radiofrequency energy was used to create linear lesion from tricuspid ring to inferior vena cava in the PI group and from tricuspid ring to Eustachian ridge in the SI group. The ablation technique was changed to the other, if one of the ablation techniques failed to block the isthmus after eight applications of radiofrequency energy. The endpoint of successful ablation included a complete bidirectional conduction block at isthmus and inability to induce atrial flutter.
, http://www.100md.com
Results: Atrial flutter was present at the onset of ablation in 10 patients of the PI group and in 15 patients of the SI group, however the cycle lengths of atrial flutter between the two groups were 240±30 ms and 220±23 ms (p<0.05), respectively. The endpoint of successful ablation was achieved in all of the patients without any complication. The ablation technique was changed for two patients in both groups after the primary ablation technique was unsuccessful. The times of radiofrequency application and procedure time were not significantly different in both groups. During a mean follow-up of 15.4±3.8 months, one patient (PI group) experienced atrial flutter recurrence.
Conclusion: Radiofrequency ablation of typical atrial flutter is safe and effective with either the posterior isthmus ablation technique or the septal isthmus ablation technique. The ablation success rate can be increased when these two techniques are used alternatively., 百拇医药