目的 探讨增加导管接触力诱发消融法治疗常规消融失败的房室结折返性心动过速(atrioventricular nodal reentrant tachycardia,AVNRT)的临床疗效。方法 2017-10至2021-04在武警特色医学中心就诊的顽固性AVNRT患者5例,无器质性心脏病证据。采用Carto-3系统,按照常规方法消融,出现持续性交界区心律,达到有效消融终点后仍能诱发AVNRT。采取增加导管接触力压迫原消融区诱发心动过速的方式,探寻不可诱发点,在该点位加压持续消融。结果 5例手术全部成功,操作时长为(9.4±2.4)min,不可诱发心动过速的平均接触力为(15.4±2.2)g,加压消融最大接触力为(10.4±2.3)g,相比常规消融(5.8±1.6)g,显著增加,差异有统计学意义(P＜0.01)。累计放电时长为(68.6±8.5)s,围手术期未出现严重并发症。术后随访6～42个月,平均(18.6±14.4)个月,无心动过速复发。结论 对于常规消融达到有效终点仍可诱发心动过速的顽固性AVNRT病例,采用增加导管接触力诱发消融法,简便快捷,安全有效。
Abstract
Objective To evaluate the effect of increased contact force ablation in patients with atrioventricular nodal reentrant tachycardia (AVNRT) after unsuccessful routine procedure. Methods Five retrospective cases (no evidence of organic heart disease) admitted in Characteristic Medical Center of Chinese People's Armed Police Force between October 2017 and April 2021 were enrolled. Through Carto-3 system, the patients underwent ablation according to conventional method. After continuous junction rhythm appeared which meant the effective ablation endpoint, AVNRT could still be induced. Increased contact force was applied upon the first-time marked ablated point sequentially and the tachycardia was triggered repeatedly. Continuous radiofrequency ablation was performed at the non-induced point. Results Successful ablation was achieved in all 5 cases and the mean procedure time was (9.4±2.4) min. Tachycardia could not be induced at mean contact force of (15.4±2.2) g. Maximal contact force of ablation was (10.4±2.3) g, which was significantly higher than that of routine method [(5.8±1.6) g, P＜0.01]. The cumulative radiofrequency time was (68.6±8.5) s and no serious complications occurred. No recurrence of tachycardia occurred at mean (18.6±14.4) months follow-up. Conclusions Increased contact force ablation is simple, safe and effective in treating refractory AVNRT when conventional ablation fails.
关键词
电生理学 /
房室结折返性心动过速 /
导管消融 /
接触力
Key words
electrophysiology /
atrioventricular nodal reentrant tachycardia /
catheter ablation /
contact force
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参考文献
[1] Markowitz S M, Lerman B B. A contemporary view of atrioventricular nodal physiology [J]. J Interv Card Electrophysiol, 2018, 52(3):271-279.
[2] Mani B C,Pavri B B. Dual atrioventricular nodal pathways physiology: a review of relevant anatomy, electrophysiology and electrocardiographic manifestations[J].Indian Pacing Electrophysiol J, 2014,14(1): 12-25.
[3] Hollanda L, Sobral R, Luize C, et al. Atrioventricular nodal reentrant tachycardia and the dilemma of reentry circuit components: a proof of concept[J]. Heart Rhythm Case Rep, 2021, 7(7):439-441.
[4] Katritsis D G,Josephson M E. Classification, electrophysiological features and therapy of atrioventricular nodal reentrant tachycardia[J].Arrhythm Electrophysiol Rev, 2016, 5(2) : 130-135.
[5] Bearl D W, Mill L, Kugler J D,et al. Visualization of atrioventricular nodal reentry tachycardia slow pathways using voltage mapping for pediatric catheter ablation [J].Congenit Heart Dis, 2015, 10 (4) : E172-E179.
[6] Katritsis D G, Marine J E, Katritsis G, et al.Spatial characterization of the tachycardia circuit of atrioventricular nodal re-entrant tachycardia [J]. Europace, 2021, 23(10): 1596-1602.
[7] 张晓锋, 杜日映, 邵玉玲, 等. 房室结双径路慢径消融时结性心律与靶图特点关系的量化研究[J].中国心脏起搏与心电生理杂志, 2015, 29(3): 232-235.
[8] Katritsis D G,Marine J E,Contreras F M, et al.Catheter ablation of atypical atrioventricular nodal reentrant tachycardia[J]. Circulation, 2016, 134(21): 1655-1663.
[9] Wang N C. Catheter ablation via the left atrium for atrioventricular nodal reentrant tachycardia: a narrative review [J]. Heart Rhythm, 2021,2(2):187-200.
[10] Vaidya V R. Catheter ablation for atrioventricular nodal reentrant tachycardia: when all is not right, ablate what is left [J]. Indian Pacing Electrophysiol J, 2021, 21(1):11-13.
[11] Kaneko Y, Naito S, Okishige K, et al. Atypical fast-slow atrioventricular nodal reentrant tachycardia incorporating a “Superior” slow pathway: a distinct supraventricular tachyarrhythmia [J]. Circulation, 2016, 133(2): 114-123.
[12] Kaneko Y, Nakajima T, Tamura S, et al. Superior-type fast-slow atrioventricular nodal reentrant tachycardia phenotype mimicking the slow-fast type[J].Circ Arrhythm Electrophysiol, 2020, 13(11): e008732.
[13] Chua K, Upadhyay G A, Lee E, et al. High-resolution mapping of the triangle of koch: spatial heterogeneity of fast pathway atrionodal connections [J]. Heart Rhythm, 2018, 15(3):421-429.
[14] Parwani A S, Hohendanner F, Bode D, et al. The force stability of tissue contact and lesion size index during radiofrequency ablation: an ex-vivo study [J]. Pacing Clin Electrophysiol, 2020,43(3):327-331.
[15] Jiang J B, Li J Y, Jiang Z Y, et al. Impact of catheter-tissue contact force on lesion size during right ventricular outflow tract ablation in a swine mode [J]. Chin Med J (Engl), 2020, 133(14): 1680-1687.
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