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目的了解射频消融治疗各种心律失常复发原因。方法通过l108例射频消融治疗病例进行回顾性总结,对其中40例复发患者从诊断、消融部位、靶点图形、功率、即刻成功时间和术中是否诱发心动过速及术后心电生理情况以及消融技术开展时间等方面进行临床分析,总结复发原因。结果①总复发率为3.7%,其中房室折返性心动过速3.1%,房室结折返性心动过速2.6%;②对诊断复杂,右侧旁道,靶点V-Q间期小于10ms,消融功率大于25W,即刻成功长于5秒,消融时AV波稳定性差及术中未诱发心动过速的房室折返性心动过速患者容易复发(P<0.01);③对消融功率大于30W才出现结性心律,术中未诱发心动过速及术后仍存在心房回波和A-H跳跃现象的房室结折返性心动过速也容易复发(P﹤0.01);④对V-Q间期短于20ms的室性期前收缩也易复发;⑤复发病例多集中在消融技术开展的第2～5年。结论诊断是否明确,对消融靶点的掌握,消融部位及功率的选择,即刻成功时间,术中是否诱发心动过速及消融技术开展时间是引起射频消融治疗心律失常复发的主要原因。
Objective To understand the causes of various arrhythmia recurrences by radiofrequency catheter ablation. Methods A retrospective summary was made of l108 cases of radiofrequency ablation. The diagnosis, ablation site, target pattern, power, immediate success time, and whether or not intraoperative tachycardia and postoperative electrophysiology were involved were retrospectively analyzed. Ablation technology to carry out clinical analysis of time, summarize the causes of recurrence. Results ① The total recurrence rate was 3.7%, of which 3.1% was atrioventricular reentrant tachycardia and 2.6% was atrioventricular nodal reentrant tachycardia; ②For the diagnosis of complex, the right side of the bypass, target VQ interval less than 10ms, ablation Power> 25W, immediate success longer than 5 seconds, AV wave stability during ablation and intraoperative recurrence of atrioventricular reentrant tachycardia were easy to relapse (P <0.01); ③ ablation power is greater than 30W only appeared knot Ventricular arrhythmia and recurrent atrial tachycardia were still easy to relapse (P <0.01); ④For patients with VQ interval of less than 20 ms Premature contractions are also easy to relapse; ⑤ cases of recurrence and more concentrated in the first 2 to 5 years of ablation technology. Conclusions The main reasons for the recurrence of cardiac arrhythmia caused by radiofrequency ablation are the conclusion of the diagnosis, the mastery of the ablation target, the selection of ablation site and power, the success time immediately, the intraoperative tachycardia induced and the time of ablation technique.