【作者】 潘健；

【导师】 彭景添；

【作者基本信息】 江西医学院 ， 心血管内科， 2003， 硕士

【摘要】 目的 探讨RS2标测法在房室结折返性心动过速（AVNRT）慢径消融靶点定位中的作用。方法 将40例AVNRT患者随机分成二组（每组20例）即RS2组和解剖电图组，分别采用RS2标测、解剖电图标测法进行慢径标测与射频消融。RS2标测法：大头导管在Kock三角区心内电图记录到小A大V波、无H波，且心电波形稳定后，诱发心动过速，经大头导管发放RS2刺激，从少于心动过速周长20ms起搏频率开始，每次以10ms步长负扫，直至心动过速终止（或刺激不能夺获心房），最后在以最长联律间期RS2终止心动过速的位点消融。解剖电图标测法：左前斜45°，大头导管在希氏束至冠状静脉窦口之间记录到房波明显小于室波（A：V<0.5）、碎裂、呈双向、无H波且心电波形稳定，作为靶点试消融。比较两组标测靶点时间、手术操作时间、X线曝光时间、放电时间及并发症。结果 RS2组的标测时间、手术操作时间、X线曝光时间、放电时间，均少于解剖电图组，具有显著差异（P<0.01），两组消融成功率均为100%，且均未见三度房室传导阻滞（Ⅲ°AVB）等并发症。结论 RS2标测法指导慢径消融优于解剖电图标测法。更多还原

【Abstract】 Objective: To investigate the value of using RS2 in mapping the target site for slow pathway ablation.Methods:40 patients with AVNRT (atrioventricular nodal reentrant tachycardia) were randomly dividied into RS2 mapping group(20 cases) and ananatomic- electrogram mapping group (20 cases).In RS2 group,as the catheter was at the Kock triangle steady,with little A-wave and big V-wav, tachycardia was initiated with HAR stimulation , then single extrastimuli (RS2) were delivered from the ablation catheter tip beginning by 20 ms less than the tachycardia cycle length and decrementing by 10 ms until tachycardia terminated or loss of capture occurred . At last, the slow pathway was ablated at the site at which AVNRT was terminated with the longest coupling interval. In anatomic-electrogram group,between His and coronary sinus ostium with LAO 45°as the atrial wave was smaller than ventricular wave (A:V<0.5) , and fragmentive, two-dimensional,steady,without His potential.The radiofrequency current was delivered.The mapping time, procedure duration,fluoroscopy time,radiofrequency ablation time were studied.The radiofrequency energy,impedance and complication such as third-degree atrial ventricular block （Ⅲ°AVB）were observed.Results:Mapping time, procedure duration,fluoroscopy time,radiofrequency ablation time were less in RS2 group than those in anatomic-electrogram group(P<0.01). Ablation Suceess rate was 100% in two groups without the complication of Ⅲ°AVB. Conclusion: RS2 mapping should be superior to anatomic-electrogram mappingin guiding ablation for slow pathway.更多还原