CAJ | 학술논문

目的探讨经导管射频消融治疗阵发性室上性心动过速的效果及安全性.方法 2003年7月至2011年1月在厦门市心脏中心行心内电生理检查及射频消融术治疗的心动过速患者1106例,分析各型心动过速的构成比,评价术中成功率及其相关因素,长期随访观察复发率及并发症发生率.结果共纳入阵发性室上性心动过速患者1106例,男女比例为1∶1,其中房室旁道型心动过速588例,房室结折返型心动过速477例,房性心动过速41例.术中即刻消融成功1087例(98.3％,1087/1106),复发43例(3.9％,43/1106),其中房室结折返型心动过速复发7例(1.5％,7/477)；房室旁道复发33例(5.6％,33/588),左侧旁道复发16例(3.9％,16/302),右侧旁道17例(9.1％,17/186)；房性心动过速复发3例(8.1％,3/41).并发症发生率为1.5％(17/1106),主要为气胸6例,血气胸1例,肺栓塞1例,左颈皮下气肿1例,术中一过性Ⅲ度房室传导阻滞2例,术中I度房室传导阻滞3例,术后持续性Ⅲ度房室传导阻滞需植入永久性心脏起搏器2例(0.2％),术后5d心源性猝死1例,为长期中风卧床者,为手术非相关死亡.结论经导管射频消融为阵发性室上性心动过速安全有效的治疗方法.
목적 탐토경도관사빈소융치료진발성실상성심동과속적효과급안전성.방법 2003년7월지2011년1월재하문시심장중심행심내전생리검사급사빈소융술치료적심동과속환자1106례,분석각형심동과속적구성비,평개술중성공솔급기상관인소,장기수방관찰복발솔급병발증발생솔.결과 공납입진발성실상성심동과속환자1106례,남녀비례위1∶1,기중방실방도형심동과속588례,방실결절반형심동과속477례,방성심동과속41례.술중즉각소융성공1087례(98.3％,1087/1106),복발43례(3.9％,43/1106),기중방실결절반형심동과속복발7례(1.5％,7/477)；방실방도복발33례(5.6％,33/588),좌측방도복발16례(3.9％,16/302),우측방도17례(9.1％,17/186)；방성심동과속복발3례(8.1％,3/41).병발증발생솔위1.5％(17/1106),주요위기흉6례,혈기흉1례,폐전새1례,좌경피하기종1례,술중일과성Ⅲ도방실전도조체2례,술중I도방실전도조체3례,술후지속성Ⅲ도방실전도조체수식입영구성심장기박기2례(0.2％),술후5d심원성졸사1례,위장기중풍와상자,위수술비상관사망.결론 경도관사빈소융위진발성실상성심동과속안전유효적치료방법.
Objective To investigate the efficacy and safety of catheter radiofrequency ablation of paroxysmal supraventricular tachycardia.Methods From Jul 2003 to Jan 2011,1106 cases with narrow QRS complex tachycardia who were treated by catheter radiofrequency ablation were recruited from our center and followed up for the rates of successful treatment,rcurrence and complications.Results There were in total 1106 patients (atrioventricular reentrant tachycardia:588 ; atrioventricular nodal reentrant tachycardia:477; atrial tachycardia:41 ),with a sex proportion of 1∶1.Successful ablation rate was 98.3 ％ (1087/1106).Of the 1087 successful ablation cases,43 (3.9％ )were warranted repeated ablation.The recurrent rates for trioventricular nodal reentrant tachycardia,atrioventricular reentrant tachycardia,left accessory pathway and right accessory pathway were 1.5％,5.6％,3.9％,and 9.1％ respectively.Complication rate was 1.5％.The major complications included pheumothorax ( 6 cases ),pulmonary embolism ( 1 case ),transient third-degree atrioventricular block ( 2 cases ),first-degree atrioventricular block ( 3 cases ),and persistent third-degree atrioventricular block(2 cases)with pacemaker implantation.There was one case of cardiogenic sudden death 5 days after the treatment procedure.The cause of his death was chronic stroke-related but not related to the operation procedure.Conclusion Catheter ablation has high efficacy and low complication rate in long-term follow-up,and is a promising treatment for paroxysmal supraventricular tachycardia.