【摘要】：目的:房顫是臨床上最常見(jiàn)的心律失常之一。根據(jù)1980-2010年間全球21個(gè)地區(qū)的流行病學(xué)調(diào)查研究估算,2010年全球房顫患者人數(shù)為3350萬(wàn)。房顫患者易發(fā)生卒中及心力衰竭等多種并發(fā)癥,致死致殘率高,嚴(yán)重危害人類(lèi)的健康。隨著電生理技術(shù)的不斷進(jìn)步,射頻消融在房顫的治療中的地位越來(lái)越高。對(duì)于有癥狀的藥物治療無(wú)效的陣發(fā)性房顫患者,射頻消融可以作為首選的治療方案。目前房顫的射頻消融手術(shù)并沒(méi)有統(tǒng)一的術(shù)式,不同中心甚至不同術(shù)者所采用的消融方式都可能不一樣,也并非所有的術(shù)者都在房顫射頻消融手術(shù)中做了詳盡的電生理檢查。但是,在心房顫動(dòng)(房顫)射頻消融的過(guò)程中,往往有并存的其他的陣發(fā)性室上性心動(dòng)過(guò)速,進(jìn)行標(biāo)準(zhǔn)的程序刺激評(píng)估是否有共存的陣發(fā)性室上性心動(dòng)過(guò)速是非常重要的。一些房顫可能由這些室上性心動(dòng)過(guò)速誘發(fā),消融這部分室上性心動(dòng)過(guò)速可以減少房顫的發(fā)作。也有一部分患者的臨床癥狀可能來(lái)自于這些并存的室上性心動(dòng)過(guò)速。本研究分析了連續(xù)1775例首次行房顫射頻消融手術(shù)中并存的室上性心動(dòng)過(guò)速情況,為合理處理這些并發(fā)的心律失常提供一定的依據(jù)。方法:連續(xù)1775例在廣東省人民醫(yī)院住院并首次行房顫射頻消融的患者,男性1197例,女性578例,年齡57.0±11.3歲�；仡櫫怂麄兊牟±Y料,收集患者的一般情況,包括年齡、性別等資料;既往病史,包括房顫的類(lèi)型、吸煙史、飲酒史,是否存在冠心病、心肌病、瓣膜性疾病、糖尿病、卒中等;一般檢查情況,包括左房大小、左室大小,EF值、INR、頸動(dòng)脈超聲、食道超聲等;手術(shù)中的情況,包括三維標(biāo)測(cè)系統(tǒng)的類(lèi)型、術(shù)中消融的部位等資料。分析在房顫射頻消融手術(shù)過(guò)程中并存的室上性心動(dòng)過(guò)速的情況。結(jié)果:在房顫射頻消融的過(guò)程中,有2.7%的患者并存有陣發(fā)性室上性心動(dòng)過(guò)速,其中房室結(jié)雙徑路25例,左側(cè)旁道16例,右側(cè)旁道6例,心中靜脈旁路1例。所有的陣發(fā)性室上性心動(dòng)過(guò)速均被成功消融。合并陣發(fā)性室上性心動(dòng)過(guò)速與不合并陣發(fā)性室上性心動(dòng)過(guò)速的患者,其年齡、心臟大小、EF值等指標(biāo)并無(wú)統(tǒng)計(jì)學(xué)差異。結(jié)論:1.48例(2.7%)首次行射頻消融的房顫患者并存有陣發(fā)性室上性心動(dòng)過(guò)速,并存有陣發(fā)性室上性心動(dòng)過(guò)速的房顫患者左房大小較不合并陣發(fā)性室上性心動(dòng)過(guò)速的患者稍小,其他情況并無(wú)統(tǒng)計(jì)學(xué)差異。這可能意味著在左房增大以前合并有陣發(fā)性室上性心動(dòng)過(guò)速的患者更早的發(fā)生了房顫。2.陣發(fā)性室上性心動(dòng)過(guò)速可能誘發(fā)房顫,行房顫射頻消融的患者中有一部分患者的房顫可能僅僅是由陣發(fā)性室上性心動(dòng)過(guò)速誘發(fā),消融這些并存的室上性心動(dòng)過(guò)速可以中止房顫的發(fā)作。3.房顫射頻消融過(guò)程中行標(biāo)準(zhǔn)的電生理檢查鑒別出并消融這些并存的陣發(fā)性室上性心動(dòng)過(guò)速可以使首次射頻消融獲益最大化。
[Abstract]:Objective: atrial fibrillation is one of the most common arrhythmias in clinic. According to epidemiological studies conducted in 21 regions between 1980 and 2010, the number of patients with atrial fibrillation worldwide was 33.5 million in 2010. Atrial fibrillation patients are prone to many complications, such as stroke and heart failure. With the development of electrophysiological technology, radiofrequency ablation is becoming more and more important in the treatment of atrial fibrillation. Radiofrequency ablation may be the preferred treatment for patients with paroxysmal atrial fibrillation who are not treated with symptomatic drugs. At present, there is no uniform procedure for radiofrequency ablation of atrial fibrillation. Different centers and even different procedures may adopt different ablation methods, and not all of them have done detailed electrophysiological examination in radiofrequency ablation of atrial fibrillation. However, during radiofrequency ablation of atrial fibrillation (AF), there are other paroxysmal supraventricular tachycardia which often coexist. It is very important to evaluate whether there are co-existing paroxysmal supraventricular tachycardia by standard program stimulation. Some atrial fibrillation may be induced by these supraventricular tachycardia, which can be reduced by ablation of supraventricular tachycardia. Some patients may also have clinical symptoms from these coexisting supraventricular tachycardia. In this study, 1775 consecutive patients with supraventricular tachycardia during radiofrequency ablation of atrial fibrillation (AF) were analyzed, which provided a basis for the rational management of these complicated arrhythmias. Methods: 1775 consecutive patients (male 1197, female 578, age 57.0 鹵11.3 years) who were hospitalized in Guangdong Provincial people's Hospital and performed RF ablation for the first time were enrolled in this study. Their case data were reviewed and the general information of the patients was collected, including age, sex and so on. Previous history, including types of AF, smoking, alcohol consumption, coronary heart disease, cardiomyopathy, valvular disease, diabetes, stroke, etc. General examination, including left atrial size, left ventricular size, EF value, INR, carotid ultrasound, esophagus ultrasound, etc. To analyze supraventricular tachycardia during radiofrequency ablation of atrial fibrillation. Results: paroxysmal supraventricular tachycardia was found in 2.7% of the patients during radiofrequency ablation of atrial fibrillation, including 25 patients with dual atrioventricular node pathway, 16 patients with left accessory pathway, 6 patients with right accessory pathway and 1 patient with cardiac venous bypass. All paroxysmal supraventricular tachycardia were successfully ablated. There was no significant difference in age, heart size and EF between patients with paroxysmal supraventricular tachycardia and those without paroxysmal supraventricular tachycardia. Conclusion: 1.There were 48 (2.7%) patients with atrial fibrillation who underwent radiofrequency ablation for the first time and had paroxysmal supraventricular tachycardia. The size of left atrium in patients with paroxysmal supraventricular tachycardia was smaller than that in patients without paroxysmal supraventricular tachycardia. This may mean that patients with paroxysmal supraventricular tachycardia prior to enlargement of the left atrium develop atrial fibrillation earlier. Atrial fibrillation may be induced by paroxysmal supraventricular tachycardia, and atrial fibrillation may only be induced by paroxysmal supraventricular tachycardia in some patients with RF ablation of atrial fibrillation. Ablation of these coexisting supraventricular tachycardia may stop atrial fibrillation. Standard electrophysiological examination during radiofrequency ablation of atrial fibrillation identified and ablated these paroxysmal supraventricular tachycardia, which may maximize the benefits of radiofrequency ablation for the first time.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R541.7

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