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评价导管射频消融治疗峡部依赖性心房扑动 (AFL)中 ,心房激动顺序的变化与双电位标测这两种消融终点的判断方法 ,以期提高成功率 ,减少复发率。选取 1997年 11月至 2 0 0 2年 9月连续收治的 4 3例典型AFL病人。按照消融终点不同 ,以及收治时间顺序分为心房特征性激动顺序变化组 (AC组 ) ,双电位组 (DP组 )。于右房三尖瓣环与下腔静脉之间的峡部进行线性消融。AC组以出现右房特征性激动顺序的变化 (即低侧位右房刺激时呈逆钟向阻滞 ,冠状静脉窦刺激时呈顺钟向阻滞 )为依据判定为峡部双向阻滞。DP组在AC组消融结果基础上 ,以消融线上标测到宽间期双电位 (>10 0ms)为依据判定为峡部双向阻滞。随访复发率。结果 :4 3例患者 ,所有患者均达到相应的射频消融终点。DP组所有患者消融成功后双电位为 116 .6± 12 .5ms。随访 14 .5± 5 .4个月 ,AC组的复发率高于DP组 (2 3.5 %vs 0 ,P <0 .0 5 )。结论 :作为峡部双向阻滞的指征 ,宽间期双电位比心房特征性激动顺序变化更准确 ,手术成功率更高。
To evaluate the change of atrial activation sequence and the judgment of two potentiometric endpoints in the treatment of isthmus-dependent atrial flutter (AFL) by catheter radiofrequency ablation in order to improve the success rate and reduce the recurrence rate. Forty-three patients with typical AFL were selected from November 1997 to September 2002. According to the end point of ablation, and the sequence of treatment time, the patients were divided into three groups: acupuncture group (AC group) and bipotential group (DP group). Linear ablation of the isthmus between the right atrial tricuspid annulus and inferior vena cava. The AC group was judged as isthmus biphasic block based on the change of characteristic right ventricular activation sequence (ie, reverse clock block in low lateral right atrium and clockwise block in coronary sinus). On the basis of ablation results of the AC group, the DP group was judged to be isthmus biphasic block based on the detection of wide interval bipolar (> 10 ms) on the ablation line. Follow-up rate of recurrence. Results: In 43 patients, all patients achieved the corresponding end point of radiofrequency ablation. All patients in the DP group had a bipolar potential of 116.6 ± 12.5 ms after successful ablation. Followed up for 14.5 ± 5.4 months, the recurrence rate of AC group was higher than that of DP group (23.5% vs 0, P <0.05). CONCLUSIONS: As an indication of isthmic bidirectional blockade, the wide-interval bipolar changes more accurately than the atrial-specific activation sequence and has a higher success rate.