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为探讨小影像Koch三角房室结折返性心动过速 (AVNRT)病人射频消融时应注意的问题 ,右前斜位 30°透视下 ,将最大希氏束 (HBE)电位记录处与冠状静脉窦口 (CSo)处的影像距离容纳不下 3个 8F加硬大头电极者定义为小影像Koch三角 ,对 16例小影像Koch三角的AVNRT病人 ,参照慢径消融法行射频消融。结果 :16例病人中 ,成功消融靶点位于CSo水平以下者 12例 ,与CSo位于同一水平者 3例 ,位于CSo水平以上者 1例。 16例病人经消融后房室传导跳跃现象消失者 14例 ;跳跃现象存在 ,但无心房回波 ,异丙肾上腺素亦不能诱发AVNRT者 2例。上述 12例中有 1例于术中出现一过性房室阻滞 (AVB) ,术后 2 4h发生Ⅱ度Ⅱ型AVB ,出院后随访 3个月未能恢复正常 ,因心率为 38～ 5 0次 /分 ,并伴有脑供血不足症状 ,遂置入永久心脏起搏器。其余病人经过 3.5± 1.2 (0 .5～ 5 )年的随访 ,无AVNRT复发 ,亦无AVB发生。结论 :对于小影像Koch三角AVNRT病人的射频消融 ,应突破常规消融时的区位划分概念 ,主要在CSo前下方寻找并消融慢径 ,并根据放电后反应及时调整消融参数。
In order to explore the small radiographs of Koch triangle atrioventricular nodal reentrant tachycardia (AVNRT) patients with radiofrequency ablation should pay attention to the problem, the right anterior oblique 30 ° fluoroscopy, the largest His bundle (HBE) potential recorded at the coronary sinus ostium (CSo) image at least three 8F hard head electrodes are defined as small images Koch Triangle, 16 cases of small images Koch Triangle AVNRT patients, with reference to slow-path ablation radiofrequency ablation. Results: Of the 16 patients, 12 patients had successful CSA ablation, 12 had CSo level, 3 had CSo level, and 1 had CSo level. There were 14 cases of disappearance of atrioventricular conduction jump after ablation in 16 patients; jumping phenomenon existed, but no atrial echo, nor isoproterenol could induce AVNRT in 2 cases. One of the 12 cases had intraoperative AVB, and Ⅱ grade Ⅱ AVB occurred 24 hours after the operation. The patients were followed up for 3 months and were not able to return to normal after the discharge due to heart rate 38-5 0 beats / min, accompanied by symptoms of insufficient blood supply to the brain, then placed in a permanent pacemaker. The remaining patients after 3.5 ± 1.2 (0.5 ~ 5) years of follow-up, no AVNRT recurrence, no AVB occurred. Conclusion: For the radiofrequency ablation of small-image Koch Triangle AVNRT patients, the concept of location division during routine ablation should be surpassed. The main pathways are to find and ablate the slow pathway before the CSo, and to adjust the ablation parameters according to the post-discharge reaction.