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目的评价植入起搏器患者经导管射频消融治疗慢性心房颤动(房颤)的安全性。方法18例永久性心脏起搏并房颤患者,其中男性12例,女性6例,年龄55～78岁,平均年龄68.67岁(标准差8.72岁)。分析其接受导管射频消融术中全程记录的心电信息,判断有无感知、起搏功能不良及房室失夺获、噪声反转等现象,并用起搏器程控仪于导管射频消融术前及术后第1天观察房室感知、起搏阈值及电极阻抗等参数的变化。结果18例患者均顺利完成导管射频消融,肺静脉前庭电学隔离率为100%。导管射频消融前后起搏器感知、起搏阈值及阻抗的变化无统计学意义(P>0.05)。导管射频消融过程中,3例(17%)出现噪声反转,3例(17%)出现感知不良,1例(6%)出现起搏功能不良致心室失夺获,均于停止放电后恢复正常。3例(17%)慢性持续性房颤患者在电复律后出现一过性感知不良。结论射频电流和电复律可引起一过性感知、起搏功能的障碍,但一般不引起起搏、感知阈值及电极阻抗的改变。对于已植入心脏起搏器的慢性房颤患者,在需行导管射频消融术时是安全的。
Objective To evaluate the safety of catheterized radiofrequency catheter ablation in patients with chronic atrial fibrillation (atrial fibrillation) undergoing pacemaker implantation. Methods Eighteen patients with permanent cardiac pacing and atrial fibrillation were enrolled in this study. There were 12 males and 6 females, aged 55-78 years old with a mean age of 68.67 years (with a standard deviation of 8.72 years). Analysis of the catheterization of radio frequency catheter ablation in the whole record of ECG information to determine the presence or absence of perception, poor pacing function and atrioventricular nocturnal, noise reversal and other phenomena, and pacemaker programmable controller in the catheter before radiofrequency ablation and On the first postoperative day, changes of atrial sensing, pacing threshold and electrode impedance were observed. Results All 18 patients underwent successful radiofrequency ablation of the catheter. The vestibular electrical isolation rate of pulmonary veins was 100%. Pacemaker perception before and after radiofrequency catheter ablation, pacing threshold and impedance change was not statistically significant (P> 0.05). In the course of radiofrequency catheter ablation, three patients (17%) experienced noise reversal, three patients (17%) had sensory abnormalities, and one patient (6%) experienced pacing dysfunction and ventricular loss. normal. Three cases (17%) of patients with chronic persistent atrial fibrillation had a transient desensitization after electrical cardioversion. Conclusion RF current and cardioversion can cause a transient sensory, pacing dysfunction, but generally do not cause pacing, perception threshold and electrode impedance changes. For patients with chronic atrial fibrillation who have implanted cardiac pacemakers, it is safe to have a catheter radiofrequency catheter ablation.