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目的 总结 2 1例由多条折返径路引起的心动过速的电生理特点及射频消融的方法和结果。方法 回顾分析我院从 1993年至 2 0 0 2年 12月射频消融治疗快速心律失常 890例 ,其中具有多条折返径路的心动过速 2 1例 ,占 3%。均有反复发作心动过速病史。行常规心电生理检查 ,摆放高右房 (HRA)、希氏束(HIS)、右室心尖部 (RV)及冠状窦 (CS)电极。分别行心房程序刺激和心室递增刺激检测房室结前传和逆传功能 ,并试图诱发心动过速 ,必要时给予异丙肾上腺素。依据心房、心室起搏或心动过速发作时HIS、CS、HRA、心室激动顺序判断折返机制为房室结折返性心动过速 (AVNRT)或房室折返性心动过速 (AVRT)。多条径路折返的判断 :①窦性心律、心房起搏时 ,有不同心室激动顺序或δ波 ;②显性预激者 ,窦性心律时最早心室激动与AVRT时最早心室激动不在同一部位 ;③ )心室起搏或顺向AVRT时心房激动顺序不同 ;④消融过程中心房顺序发生改变而心动过速不终止或仍然可诱发心动过速 ;⑤顺向和逆向AVRT最早心房和心室激动不在同一部位。消融时采用“剥笋式”操作流程。结果 2 1例患者 ,体表心电图显性 7例 ,心动过速发作时有 2种形态者 6例 ,发作时RR间期长短交替 3例。电生理检测结果 ,有 4条旁路者 1例 ,且同时并房室结缺如 ;3?
Objective To summarize the electrophysiological characteristics and radiofrequency ablation methods and results of 21 cases of tachyarrhythmia caused by multiple reentry routes. Methods A retrospective analysis of our hospital from 1993 to December 2002 radiofrequency ablation of 890 cases of tachyarrhythmias, of which there are multiple reentrant pathway tachycardia 21 cases, accounting for 3%. Have recurrent tachycardia history. Routine electrophysiological examination, placed high right atrium (HRA), His bundle (HIS), right ventricular apex (RV) and coronary sinus (CS) electrode. Atrial procedures were stimulated and ventricular ascending stimulation to detect premature beats and retrograde atrioventricular function and attempt to induce tachycardia, if necessary, given isoproterenol. Atrioventricular nodal reentrant tachycardia (AVNRT) or atrioventricular reentrant tachycardia (AVRT) were determined according to the sequence of HIS, CS, HRA and ventricular activation according to atrial, ventricular pacing or tachycardia. Multiple path reentry judgments: ① sinus rhythm, atrial pacing, different ventricular activation sequence or δ wave; ② dominant pre-excitation, sinus ventricular arrhythmias when the earliest ventricular activation and AVRT when the earliest ventricular arrhythmia is not the same site; ③) ventricular pacing or AVRT forward when atrial activation sequence is different; ④ ablation process changes in the order of the atria and tachycardia does not terminate or can still induce tachycardia; ⑤ forward and reverse AVRT the earliest atrial and ventricular activation are not the same Site. Ablation using “peel-off-style” operation process. Results Twenty-one patients had surface electrocardiogram (ECG) in 7 cases and tachycardia in 6 cases with 2 kinds of morphological changes. The interval of RR interval was 3 cases. Electrophysiology test results, there are 4 cases of bypass in 1 case, and at the same time and atrioventricular node is missing; 3?