心房颤动射频消融中并存的阵发性室上性心动过速

发布时间：2019-01-27 22:44

【摘要】：目的:房颤是临床上最常见的心律失常之一。根据1980-2010年间全球21个地区的流行病学调查研究估算,2010年全球房颤患者人数为3350万。房颤患者易发生卒中及心力衰竭等多种并发症,致死致残率高,严重危害人类的健康。随着电生理技术的不断进步,射频消融在房颤的治疗中的地位越来越高。对于有症状的药物治疗无效的阵发性房颤患者,射频消融可以作为首选的治疗方案。目前房颤的射频消融手术并没有统一的术式,不同中心甚至不同术者所采用的消融方式都可能不一样,也并非所有的术者都在房颤射频消融手术中做了详尽的电生理检查。但是,在心房颤动(房颤)射频消融的过程中,往往有并存的其他的阵发性室上性心动过速,进行标准的程序刺激评估是否有共存的阵发性室上性心动过速是非常重要的。一些房颤可能由这些室上性心动过速诱发,消融这部分室上性心动过速可以减少房颤的发作。也有一部分患者的临床症状可能来自于这些并存的室上性心动过速。本研究分析了连续1775例首次行房颤射频消融手术中并存的室上性心动过速情况,为合理处理这些并发的心律失常提供一定的依据。方法:连续1775例在广东省人民医院住院并首次行房颤射频消融的患者,男性1197例,女性578例,年龄57.0±11.3岁。回顾了他们的病例资料,收集患者的一般情况,包括年龄、性别等资料;既往病史,包括房颤的类型、吸烟史、饮酒史,是否存在冠心病、心肌病、瓣膜性疾病、糖尿病、卒中等;一般检查情况,包括左房大小、左室大小,EF值、INR、颈动脉超声、食道超声等;手术中的情况,包括三维标测系统的类型、术中消融的部位等资料。分析在房颤射频消融手术过程中并存的室上性心动过速的情况。结果:在房颤射频消融的过程中,有2.7%的患者并存有阵发性室上性心动过速,其中房室结双径路25例,左侧旁道16例,右侧旁道6例,心中静脉旁路1例。所有的阵发性室上性心动过速均被成功消融。合并阵发性室上性心动过速与不合并阵发性室上性心动过速的患者,其年龄、心脏大小、EF值等指标并无统计学差异。结论:1.48例(2.7%)首次行射频消融的房颤患者并存有阵发性室上性心动过速,并存有阵发性室上性心动过速的房颤患者左房大小较不合并阵发性室上性心动过速的患者稍小,其他情况并无统计学差异。这可能意味着在左房增大以前合并有阵发性室上性心动过速的患者更早的发生了房颤。2.阵发性室上性心动过速可能诱发房颤,行房颤射频消融的患者中有一部分患者的房颤可能仅仅是由阵发性室上性心动过速诱发,消融这些并存的室上性心动过速可以中止房颤的发作。3.房颤射频消融过程中行标准的电生理检查鉴别出并消融这些并存的阵发性室上性心动过速可以使首次射频消融获益最大化。
[Abstract]:Objective: atrial fibrillation is one of the most common arrhythmias in clinic. According to epidemiological studies conducted in 21 regions between 1980 and 2010, the number of patients with atrial fibrillation worldwide was 33.5 million in 2010. Atrial fibrillation patients are prone to many complications, such as stroke and heart failure. With the development of electrophysiological technology, radiofrequency ablation is becoming more and more important in the treatment of atrial fibrillation. Radiofrequency ablation may be the preferred treatment for patients with paroxysmal atrial fibrillation who are not treated with symptomatic drugs. At present, there is no uniform procedure for radiofrequency ablation of atrial fibrillation. Different centers and even different procedures may adopt different ablation methods, and not all of them have done detailed electrophysiological examination in radiofrequency ablation of atrial fibrillation. However, during radiofrequency ablation of atrial fibrillation (AF), there are other paroxysmal supraventricular tachycardia which often coexist. It is very important to evaluate whether there are co-existing paroxysmal supraventricular tachycardia by standard program stimulation. Some atrial fibrillation may be induced by these supraventricular tachycardia, which can be reduced by ablation of supraventricular tachycardia. Some patients may also have clinical symptoms from these coexisting supraventricular tachycardia. In this study, 1775 consecutive patients with supraventricular tachycardia during radiofrequency ablation of atrial fibrillation (AF) were analyzed, which provided a basis for the rational management of these complicated arrhythmias. Methods: 1775 consecutive patients (male 1197, female 578, age 57.0 卤11.3 years) who were hospitalized in Guangdong Provincial people's Hospital and performed RF ablation for the first time were enrolled in this study. Their case data were reviewed and the general information of the patients was collected, including age, sex and so on. Previous history, including types of AF, smoking, alcohol consumption, coronary heart disease, cardiomyopathy, valvular disease, diabetes, stroke, etc. General examination, including left atrial size, left ventricular size, EF value, INR, carotid ultrasound, esophagus ultrasound, etc. To analyze supraventricular tachycardia during radiofrequency ablation of atrial fibrillation. Results: paroxysmal supraventricular tachycardia was found in 2.7% of the patients during radiofrequency ablation of atrial fibrillation, including 25 patients with dual atrioventricular node pathway, 16 patients with left accessory pathway, 6 patients with right accessory pathway and 1 patient with cardiac venous bypass. All paroxysmal supraventricular tachycardia were successfully ablated. There was no significant difference in age, heart size and EF between patients with paroxysmal supraventricular tachycardia and those without paroxysmal supraventricular tachycardia. Conclusion: 1.There were 48 (2.7%) patients with atrial fibrillation who underwent radiofrequency ablation for the first time and had paroxysmal supraventricular tachycardia. The size of left atrium in patients with paroxysmal supraventricular tachycardia was smaller than that in patients without paroxysmal supraventricular tachycardia. This may mean that patients with paroxysmal supraventricular tachycardia prior to enlargement of the left atrium develop atrial fibrillation earlier. Atrial fibrillation may be induced by paroxysmal supraventricular tachycardia, and atrial fibrillation may only be induced by paroxysmal supraventricular tachycardia in some patients with RF ablation of atrial fibrillation. Ablation of these coexisting supraventricular tachycardia may stop atrial fibrillation. Standard electrophysiological examination during radiofrequency ablation of atrial fibrillation identified and ablated these paroxysmal supraventricular tachycardia, which may maximize the benefits of radiofrequency ablation for the first time.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.7

【参考文献】