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比较在心房扑动 (AFL)时、冠状静脉窦口 (CSO)或低外侧右房 (LRA)起搏下和窦性心律 (简称窦律 )下消融Ⅰ型AFL的优缺点。 48例阵发性AFL随机分为AFL消融组、起搏消融组和窦律消融组 ,对下腔静脉口和三尖瓣环之间的后峡部作线性消融 ,终点为后峡部双向传导阻滞。比较三组患者的电生理参数、急性成功率和远期效果。结果 :三组均达到后峡部双向阻滞 ,随访 2 1.8± 5 .6个月无AFL复发。AFL消融组在AFL终止后均不能达到后峡部双向阻滞 ,需继续在起搏下消融。起搏消融组的操作和曝光时间、放电能量和次数小于其他两组 (P <0 .0 5 )。三组在后峡部双向阻滞后记录局部心房双电位的阳性率为 37.5 %。结论 :①对Ⅰ型AFL采用窦律消融法、起搏消融法和AFL消融法都能取得满意的近远期疗效。②后峡部双向传导阻滞是保证近远期疗效的重要消融终点。③在消融部位标测到双电位可作为消融有效的指标 ,但不能代替后峡部双向阻滞作为消融终点。④起搏消融法的操作和曝光时间、放电能量和次数明显少于在AFL和窦律下消融 ,可作为常规方法使用
To compare the advantages and disadvantages of ablation type Ⅰ AFL under coronary sinus ostium (CSO) or low lateral right atrium (LRA) pacing and sinus rhythm (sinus rhythm) in atrial flutter (AFL). 48 cases of paroxysmal AFL were randomly divided into AFL ablation group, pacing ablation group and sinus rhythm ablation group, the posterior isthmus between the IVC and the tricuspid annulus for linear ablation, the end point for the posterior isthmus two-way conduction block . The electrophysiological parameters, acute success rate and long-term effect of the three groups were compared. Results: All three groups reached the posterior isthmus bifacial block, followed up for 2 1.8 ± 5. 6 months without AFL recurrence. AFL ablation group after AFL termination can not reach the posterior isthmus two-way block, the need to continue ablation under pacing. Pacing ablation group operation and exposure time, discharge energy and the number of times less than the other two groups (P <0.05). Three groups in the posterior isthmus two-way block recording local atrial bi-potential positive rate was 37.5%. CONCLUSION: ①There are satisfactory short-term and long-term effects of type Ⅰ AFL using sinus rhythm ablation, pacing ablation and AFL ablation. ② posterior isthmus two-way conduction block is to ensure long-term efficacy of an important end point of ablation. ③ measured in the ablation site bipotential can be used as an effective indicator of ablation, but can not replace the posterior isthmus block as the ablation end point. ④ pacing ablation method of operation and exposure time, discharge energy and frequency significantly less than the AFL and sinus rhythm ablation, can be used as a routine method