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目的探讨在何种影像体位下慢径消融靶点至His束的距离最远,以提高手术安全性,降低房室传导阻滞等并发症的发生率。方法入选连续30例经常规电生理检查明确诊断为房室结折返性心动过速(AVNRT)的患者,并接受射频导管消融房室结慢径治疗成功的病例,比较传统右前斜位(RAO)30°投照体位,与RAO 30°+足位(CAUD)10°和RAO 30°+CAUD 15°时,Koch三角的高度(CSo-HIS)和有效慢径消融区域与HIS束的直线距离(ABL-HIS)。结果 30例AVNRT患者,在RAO30°、RAO 30°+CAUD10°和RAO 30°+CAUD 15°时,ABL-HIS距离分别为(13.6±1.8)、(18.8±3.5)和(17.5±3.1)mm,且ABL-HIS的距离与CSo-HIS高度成正比(r=0.503,P=0.005)。(1)当心胸比率≥0.5时,ABL-HIS的距离分别为(13.4±1.0)、(15.7±1.7)、(18.3±3.7)mm;CSo-HIS高度分别为(21.9±1.3)、(25.5±2.2)、(29.5±5.1)mm;(2)当心胸比率<0.5时,ABL-HIS的距离分别为(13.8±2.3)、(21.6±1.8)、(16.8±2.3)mm;CSo-HIS高度分别为(19.7±2.2)、(28.5±4.7)、(25.3±4.5)mm。结论在AVNRT房室结慢径的射频导管消融中:(1)ABL-HIS距离与CSo-HIS高度成正比,与性别、年龄、身高、体重、体重指数无关;(2)采用RAO 30°+足位10°~15°在绝大多数患者中优于传统的RAO 30°体位。
OBJECTIVE: To determine the location of the target of slow-pathway ablation to the farthest extent of His beam under different imaging positions so as to improve the safety of surgery and reduce the incidence of complications such as atrioventricular block. Methods A total of 30 consecutive patients with AVNRT diagnosed by routine electrophysiological examination were enrolled in this study. Radiofrequency catheter ablation of atrioventricular nodal slow pathway was used to treat the patients successfully. Compared with the conventional right anterior oblique (RAO) (CSo-HIS) and the linear distance from the effective slow-pathway ablation region to the HIS bundle at (30 ° + 10 ° CAUD and 30 ° CAUD + RAUD 30 ° CAUD ABL-HIS). Results In 30 patients with AVNRT, ABL-HIS distances were (13.6 ± 1.8), (18.8 ± 3.5) and (17.5 ± 3.1) mm respectively at RAO 30 °, RAO 30 ° + CAUD 10 ° and RAO 30 ° + CAUD 15 ° , And the distance of ABL-HIS was highly proportional to CSo-HIS (r = 0.503, P = 0.005). (1) The distance of ABL-HIS was (13.4 ± 1.0), (15.7 ± 1.7) and (18.3 ± 3.7) mm respectively when the heart rate was ≥ 0.5. The height of CSo-HIS was (21.9 ± 1.3) and ± 2.2) and (29.5 ± 5.1) mm, respectively. (2) The distance of ABL-HIS was (13.8 ± 2.3), (21.6 ± 1.8) and (16.8 ± 2.3) mm, The height were (19.7 ± 2.2), (28.5 ± 4.7) and (25.3 ± 4.5) mm, respectively. Conclusions In radiofrequency catheter ablation of AVNRT with atrioventricular nodal slow pathway: (1) The distance between ABL-HIS and CSo-HIS is highly proportional to sex, age, height, weight and body mass index; (2) Foot position 10 ° ~ 15 ° in the vast majority of patients than the traditional RAO 30 ° position.