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目的:探讨邻近希氏束的快速心律失常患者射频消融的策略。方法:对43例邻近希氏束的心动过速患者常规进行电生理检查,明确其机制后采取相应措施进行经导管射频消融术(RFCA)。希氏束旁路的消融在心动过速时进行,而室性心动过速则在窦性心律时消融。记录手术过程、所用器材及并发症发生情况。结果:43例中,10例为希氏束旁路,2例为房性心动过速,30例为房室结折返性心动过速,1例为特发性左心室室性心动过速。首次射频消融成功率为93%(40/43),复发2例,再次消融均成功。30例使用了SwartzR0鞘管。3例房室结双径路患者消融慢径路时出现一过性房室阻滞。结论:邻近希氏束的心动过速射频消融成功率较高,但有一定的特殊性,应采取不同的消融策略,术中尤需避免损伤希氏束。
Objective: To explore the strategy of radiofrequency ablation in patients with tachyarrhythmia near His bundle. Methods: Forty-three patients with tachycardia adjacent to His bundle were routinely performed electrophysiological examination. After the mechanism was clarified, the corresponding measures were taken to perform RFCA. His bundle bypass is performed during tachycardia, while ventricular tachycardia ablates during sinus rhythm. Record surgical procedures, equipment and complications occurred. Results: Of the 43 cases, 10 were His bundle bypass, 2 were atrial tachycardia, 30 were atrioventricular nodal reentrant tachycardia and 1 was idiopathic left ventricular tachycardia. The success rate of the first radiofrequency ablation was 93% (40/43), and 2 cases were relapsed, and the ablation was successful again. Thirty patients used the SwartzR0 sheath. Atrioventricular block was found in 3 cases of dual node pathway pathway ablation in slow pathway. CONCLUSION: The success rate of RF ablation of tachycardia adjacent to His bundle is high, but there is a certain degree of specificity. Different ablation strategies should be taken in order to avoid injury to His bundle.