Radiofrequency catheter ablation for the refractory atrioventricular nodal reentrant tachycardia
- VernacularTitle:顽固性房室结折返性心动过速的射频导管消融术
- Author:
Ping LI
- Publication Type:Journal Article
- Keywords:
Refractory atrioventricular nodal reentrant tachycardia;
Radiofrequency catheter ablation
- From:
Journal of Medical Postgraduates
2004;0(02):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To analyze the elcctrophysiological and clinical features of 68 common and 9 refractory atrioventricular nodal reentrant tachycardia(AVNRT) cases,thereby to seek safe and effective strategies for the treatment of refractory AVNRT with radiofrequency catheter ablation(RFCA). Methods: Ablation at lower zone is customarily applied in AVNRT,if noneffective,ablation electrode can be gradually moved upward,and radiofrequency energy can be delivered at a midpoint or upper position of His Bundle even with small H waves.The movement of the ablation electrode must be carefully monitored lest His bundle be eroded mistakenly.For those both atrioventricular nodal dual pathways(AVNDP) and atrioventricular accessory pathways(AVAP) are present,we always ablate AVAP first. Results: All 68 common AVNRT cases are simple slow-fast type.Among the 9 cases of refractory AVNRT,2 cases were combined with concealed left postseptal AVAP and concealed right AVAP respectively,while 1 case with atrioventricular nodal three pathways. Conclusion: X-ray anatomical position and intraventricular local mapping should be analyzed for the use of RFCA in refractory AVNRT.Safe and effective mapping should be: small A wave and big V wave,shattered A wave with width≥68 ms,A/V= 0.1-0.25,no H or H≤(0.02?0.03) mV.If lower position and middle position method are noneffective,linear ablation at mid-level of Koch's triangle seems to be a satisfactory alternative,which could avoid complications of atrioventricular block in the upper position ablation.
