心房扑动单径线径消融及方法改良的评价(摘要)
作者：马长生 颜红兵 王勇 周玉杰 赵丽华 董建增 刘旭
单位：北京市，中日友好医院 心内科(100029) 马长生 颜红兵 王 勇 周玉杰； 白求恩医科大学第一附属医院 赵丽华(第三作者)； 河南医科大学第一附属医院 董建增(第四作者)；上海胸科医院 刘 旭(第五作者)
关键词：
目的 目的：比较经典法与改良单径线(TV-IVC)法消融治疗64例常见型心房扑动(AF)的结果。
方法：前29例为Ⅰ组，后35例为Ⅱ组。Ⅰ组采用解剖和心内电位图定位，使用弯曲长度2.5英寸的8 F Webster消融导管行TV-IVC+TV-CS+CS-IVC三线径消融。输出功率30 W。X线透视下边放电边移动消融导管电极，每次移动3 mm、放电10 s。连续放电100 s消融1条径线1次，重复多次。消融TV-IVC径线不成功时，再消融TV-CS和CS-IVC径线。Ⅱ组采用改良单径线消融。使用弯曲长度1.5～3.0英寸的7 F或8 F多种Webster和Daig消融导管。导管走行与贴靠不稳定时使用Swartz AF鞘。输出功率10～50 W。左前斜位定方向，右前斜位移动消融导管。每次移动导管3 mm、放电30 s。连续放电200 s消融TV-IVC径线一次。在右心房与IVC交界处，加用短弯Webster消融导管作补充消融。峡部缓慢传导区双向阻滞为消融终点。消融要点是消融径线方向一致，导管贴靠稳定，TV环消融起始点明显低于CS口水平。
, 百拇医药
结果：Ⅰ组和Ⅱ组消融成功率分别为75.9%和97.1%(P<0.05)。Ⅰ组中永久性或一过性完全性房室传导阻滞4例。两组操作用时(263±52 min vs. 198±37 min)、平均透视时间(71±34 min vs. 47±21 min)和累积放电时间(2 157±754 s vs. 1 246±429 s)均有明显差异(P<0.05)。
结论：单径线消融即可有效地阻断TV-IVC峡部传导，治愈AF。改良的单径线消融方法简便、安全，可以明显缩短操作、透视和累积放电的时间，避免TV-CS消融时损伤房室结导致的完全性房室传导阻滞。
Single Line Radiofrequency Ablation of Atrial Flutter and its Modification (Abstract)
Department of Cardiology, China-Japan Friendship Hospital, Beijing (100029)
, 百拇医药
Ma Changsheng, Yan Hongbing, Zhao Lihua, et al.
Objective: To report our results of radiofrequency ablation for typical atrial flutter (AF) in 64 patients by using conventional three-line (TV-IVC, TV-CS and CS-IVC line) ablation and a modified single line (TV-IVC line) ablation.
Methods: The first 29 patients and the last 35 were assigned to group Ⅰ and group Ⅱ respectively. In group Ⅰ, based on characteristic anatomy and intracardiac electrogram, three-line ablation was carried out by using a 8 F flexible-tip (2.5 inch) Webster catheter with an output power of 30 W. Under fluoroscopic guidance, radiofrequency energy was continuously delivered for 10 s after the ablation catheter was moved about 3 mm, and 100 s delivery of radiofrequency energy for one line was needed in one session. Further ablation of the other two lines (TV-CS and CS-IVC) was performed when TV-IVC line failed to be ablated. In group Ⅱ, a modified single line ablation was applied by using various 7～8 F fiexible-tip (1.5～3.0 inch) Webster and Daig catheters with an output power of 10～50 W. Intravascular Swartz AF sheaths were used for positioning and stablization of the catheter when the positioning and stablization could not be achieved. Under fluoroscopic guidance, the ablation catheter course was determined in a LAO view, and the catheter was moved in a RAO view. Radiofrequency energy was continuously delivered for 30 s after the ablation catheter was moved about 3 mm, and 200 s delivery of radiofrequency energy for TV-IVC line was needed in one session. A complementary ablation was used at a conjunction of the right atrium and IVC with the help of a short flexible-tip Webster catheter. Creation of bidirectional conduction block at the low right atrial isthmus was used as an endpoint of radiofrequency ablation. A few key points included continuity of ablation lesions, positioning and stablization of catheter, and starting point of the TV annulus ablation lower than the ostium of the CS.
, http://www.100md.com
Results: Successful ablation was archieved in 75.9% of the patients in group Ⅰ and in 97.1% in group Ⅱ (p<0.05). Permanent or transient complete AV block occurred in four patients in group Ⅰ. A great difference was shown in procedural time (263±52 min vs. 198±37 min, respectively), average fluoroscopic time (71±34 min vs. 47±21 min, respectively) and accumulated energy delivery time (2 157±754 s vs. 1 246±429 s) between group Ⅰ and group Ⅱ (p<0.05).
Conclusions: Single line (TV-IVC line) ablation may produce an effective creation of conduction block at the isthmus between TV and IVC, and a consequent curative effect in AF. Modified single line ablation was proved to be a simple and safe modality, which may shorten the time in performance, fluoroscopic guidance and energy deliveries, and may prevent the AV node from potential injury which may result in complete AV block during ablation procedure at the isthmus between TV and IVC., 百拇医药
单位：北京市，中日友好医院 心内科(100029) 马长生 颜红兵 王 勇 周玉杰； 白求恩医科大学第一附属医院 赵丽华(第三作者)； 河南医科大学第一附属医院 董建增(第四作者)；上海胸科医院 刘 旭(第五作者)
关键词：
目的 目的：比较经典法与改良单径线(TV-IVC)法消融治疗64例常见型心房扑动(AF)的结果。
方法：前29例为Ⅰ组，后35例为Ⅱ组。Ⅰ组采用解剖和心内电位图定位，使用弯曲长度2.5英寸的8 F Webster消融导管行TV-IVC+TV-CS+CS-IVC三线径消融。输出功率30 W。X线透视下边放电边移动消融导管电极，每次移动3 mm、放电10 s。连续放电100 s消融1条径线1次，重复多次。消融TV-IVC径线不成功时，再消融TV-CS和CS-IVC径线。Ⅱ组采用改良单径线消融。使用弯曲长度1.5～3.0英寸的7 F或8 F多种Webster和Daig消融导管。导管走行与贴靠不稳定时使用Swartz AF鞘。输出功率10～50 W。左前斜位定方向，右前斜位移动消融导管。每次移动导管3 mm、放电30 s。连续放电200 s消融TV-IVC径线一次。在右心房与IVC交界处，加用短弯Webster消融导管作补充消融。峡部缓慢传导区双向阻滞为消融终点。消融要点是消融径线方向一致，导管贴靠稳定，TV环消融起始点明显低于CS口水平。
, 百拇医药
结果：Ⅰ组和Ⅱ组消融成功率分别为75.9%和97.1%(P<0.05)。Ⅰ组中永久性或一过性完全性房室传导阻滞4例。两组操作用时(263±52 min vs. 198±37 min)、平均透视时间(71±34 min vs. 47±21 min)和累积放电时间(2 157±754 s vs. 1 246±429 s)均有明显差异(P<0.05)。
结论：单径线消融即可有效地阻断TV-IVC峡部传导，治愈AF。改良的单径线消融方法简便、安全，可以明显缩短操作、透视和累积放电的时间，避免TV-CS消融时损伤房室结导致的完全性房室传导阻滞。
Single Line Radiofrequency Ablation of Atrial Flutter and its Modification (Abstract)
Department of Cardiology, China-Japan Friendship Hospital, Beijing (100029)
, 百拇医药
Ma Changsheng, Yan Hongbing, Zhao Lihua, et al.
Objective: To report our results of radiofrequency ablation for typical atrial flutter (AF) in 64 patients by using conventional three-line (TV-IVC, TV-CS and CS-IVC line) ablation and a modified single line (TV-IVC line) ablation.
Methods: The first 29 patients and the last 35 were assigned to group Ⅰ and group Ⅱ respectively. In group Ⅰ, based on characteristic anatomy and intracardiac electrogram, three-line ablation was carried out by using a 8 F flexible-tip (2.5 inch) Webster catheter with an output power of 30 W. Under fluoroscopic guidance, radiofrequency energy was continuously delivered for 10 s after the ablation catheter was moved about 3 mm, and 100 s delivery of radiofrequency energy for one line was needed in one session. Further ablation of the other two lines (TV-CS and CS-IVC) was performed when TV-IVC line failed to be ablated. In group Ⅱ, a modified single line ablation was applied by using various 7～8 F fiexible-tip (1.5～3.0 inch) Webster and Daig catheters with an output power of 10～50 W. Intravascular Swartz AF sheaths were used for positioning and stablization of the catheter when the positioning and stablization could not be achieved. Under fluoroscopic guidance, the ablation catheter course was determined in a LAO view, and the catheter was moved in a RAO view. Radiofrequency energy was continuously delivered for 30 s after the ablation catheter was moved about 3 mm, and 200 s delivery of radiofrequency energy for TV-IVC line was needed in one session. A complementary ablation was used at a conjunction of the right atrium and IVC with the help of a short flexible-tip Webster catheter. Creation of bidirectional conduction block at the low right atrial isthmus was used as an endpoint of radiofrequency ablation. A few key points included continuity of ablation lesions, positioning and stablization of catheter, and starting point of the TV annulus ablation lower than the ostium of the CS.
, http://www.100md.com
Results: Successful ablation was archieved in 75.9% of the patients in group Ⅰ and in 97.1% in group Ⅱ (p<0.05). Permanent or transient complete AV block occurred in four patients in group Ⅰ. A great difference was shown in procedural time (263±52 min vs. 198±37 min, respectively), average fluoroscopic time (71±34 min vs. 47±21 min, respectively) and accumulated energy delivery time (2 157±754 s vs. 1 246±429 s) between group Ⅰ and group Ⅱ (p<0.05).
Conclusions: Single line (TV-IVC line) ablation may produce an effective creation of conduction block at the isthmus between TV and IVC, and a consequent curative effect in AF. Modified single line ablation was proved to be a simple and safe modality, which may shorten the time in performance, fluoroscopic guidance and energy deliveries, and may prevent the AV node from potential injury which may result in complete AV block during ablation procedure at the isthmus between TV and IVC., 百拇医药