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目的总结顽固性阵发性房颤伴病窦综合征患者的心电图和动态心电图特点。评估心脏起搏和射频消融心房肺静脉电隔离治疗的结果。方法 5例阵发性房颤患者。年龄62(60.7±6.8)岁。4例有黑朦,1例有晕厥发作史,病史1~5(2.6±1.3)年。全部病例完行心内电生理检查和心房肺(或上腔)静脉电隔离。结果5例患者中,每周均有发作数次的3例,有2例植入DDD心脏起搏器,其中1例系导管射频消融术后1周植入起搏器,另1例系植入起搏器后房颤频繁发作行导管射频消融。动态心电图示房颤终止后的平均窦性停搏时间为5(5.0±1.9)s。心内电生理检查证实与房颤相关的靶静脉为上腔静脉1例,右上肺静脉1例,左上肺静脉2例,有1例未能确定起源点。作射频消融电隔离肺静脉共22根,平均随访3(2.78±1.59)月,无房颤发作。未植入起搏器的3例多次动态心电图复查无窦性停搏发生,24h总心率均在正常范围。结论部分阵发性房颤伴病态窦综合征的患者,导管射频消融电隔离肺静脉后能有效地消除房颤发作,窦房结功能可以恢复。建议对这些患者首先行肺静脉电隔离治疗控制房颤,然后根据自身心率的变化评估心脏起搏治疗的必要。
Objective To summarize the characteristics of electrocardiogram and electrocardiogram in patients with refractory paroxysmal atrial fibrillation and sick sinus syndrome. Evaluation of cardiac pacing and radiofrequency ablation of atrial and pulmonary venous isolation results. Methods Five patients with paroxysmal atrial fibrillation. Age 62 (60.7 ± 6.8) years old. 4 cases had amaurosis, 1 case had a history of syncope, history 1 ~ 5 (2.6 ± 1.3) years. All patients completed cardiac electrophysiology and atrial pulmonary (or superior vena cava) electrical isolation. Results Among 5 patients, 3 cases were attacked several times per week, 2 cases were implanted DDD pacemakers, 1 case was implanted with pacemaker one week after radiofrequency catheter ablation and the other 1 case was implanted Atrial fibrillation into the pacemaker frequent episodes of catheter radiofrequency ablation. Holter tests showed a mean sinus arrest time of 5 (5.0 ± 1.9) s after atrial fibrillation. Cardiac electrophysiological examination confirmed that the target vein associated with atrial fibrillation was superior vena cava in 1 case, right superior pulmonary vein in 1 case, left superior pulmonary vein in 2 cases, and 1 case failed to identify the origin. A total of 22 pulmonary vein radiofrequency ablation were performed with a mean follow-up of 3 months (2.78 ± 1.59 months) without atrial fibrillation. No implant pacemaker in 3 cases of multiple dynamic electrocardiogram review without sinus arrest, 24h total heart rate in the normal range. Conclusions Some patients with paroxysmal atrial fibrillation and sick sinus syndrome can effectively eliminate the onset of atrial fibrillation by radiofrequency catheter ablation and pulmonary vein isolation, and the function of the sinus node can be recovered. It is recommended that these patients be treated with pulmonary vein electrical isolation for the first time to control atrial fibrillation and then assess the need for cardiac pacing therapy based on changes in their heart rate.