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目的:探讨单导管标测法在心房扑动(房扑)射频消融中的应用方法和效果。方法:阵发性心房颤动并发房扑患者行肺静脉电隔离术时采用单导管标测法消融房扑30例。所有患者行肺静脉电隔离术后,将10极冠状静脉窦(CS)导管远端2对电极放置于CS内,余位于CS外,并使之有一定的张力,使导管贴靠于三尖瓣环和低右房。用冷盐水灌注消融导管线性消融三尖瓣峡部,房扑发作患者在房扑下消融,窦律患者在CS远端电极起搏下消融,可在术中随时把大头消融导管置于希氏束部位,用于评价是否已完全达双向阻滞,即:起搏CS远端电极,刺激信号至CS近端电极A波的距离大于至希氏束A波的距离,则CS口至低右房单向阻滞;CS近端电极起搏,刺激信号至CS远端电极A波的距离大于至希氏束A波的距离,则低右房至CS口单向阻滞,从而达双向阻滞,CS近端电极起搏所需电压较高,有的患者可达24mA。结果:所用阵发性心房颤动并发房扑患者均成功行三尖瓣峡部线性射频消融,达到双向阻滞,无手术相关并发症,随访4个月～2年,无房扑复发。结论:单导管标测法对房扑患者行三尖瓣峡部线性射频消融操作简单、快速,可完全用于评价消融结果,成功率高,并且节省手术费用。
Objective: To explore the application method and effect of single catheter in radiofrequency ablation of atrial flutter (atrial flutter). Methods: Thirty patients with paroxysmal atrial fibrillation complicated with atrial flutter underwent pulmonary catheter isolation by a single catheter. All patients undergoing pulmonary vein isolation, the 10 electrodes of the distal coronary venous catheter (CS) 2 pairs of electrodes placed in the CS, the rest in CS, and make it a certain tension, the catheter against the tricuspid valve Ring and low right room. With cold saline infusion ablation catheter linear ablation of the tricuspid isthmus, atrial flutter episodes of atrial flutter in patients with ablation, sinus rhythm patients under CS distal electrode pacing ablation, at any time in the bulk of the ablation catheter placed His bundle Site, used to evaluate whether it has completely reached the bidirectional block, that is: pacing CS distal electrode, stimulus signal to CS proximal electrode A wave distance greater than the His bundle A wave distance, the CS port to the low right room Unidirectional block; CS proximal electrode pacing, stimulation signal to CS far electrode A wave distance greater than the His bundle A wave distance, then the low right atrial to CS port unidirectional block, so as to achieve two-way block , CS proximal electrode pacing higher voltage required, and some patients up to 24mA. Results: All the patients with paroxysmal atrial fibrillation complicated by atrial flutter successfully underwent linear radiofrequency ablation of the tricuspid isthmus and reached the bidirectional block. There were no complications related to surgery. The patients were followed up for 4 months to 2 years without any recurrence of atrial flutter. Conclusion: The single catheterization method for patients with atrial flutter linear radio frequency ablation of tricuspid isthmion simple, fast, can be completely used to evaluate the ablation results, high success rate, and save the cost of surgery.