| Atrioventricular nodal reentrant tachycardia ( AVNRT) is a very common kind of SVT, 40 -50% of all SVT inland0 In the past, people use medicine to control AVNRT, but many persons were obliged to stop the medicine for not -enduring the side effect. Since 1987, radiofrequency ablation has become the only real radical technology for some kinds of arrhythmia and has been recognized to be the first choice for the curing of AVNRT. At present, the successful rate of using ablation to treat AVNRT is well, but difficult cases present continuously, and operation difficulty is also increasing. Sometimes the following are probably present: (1) operation discharging time prolonged, ( 2) post - operation recrudesce happen, and (3 ) the occurrence of AVB increase. This requires finding the effective complementary method for the original technology on the base of the traditional theory and technology. Following the progressing of cardiac electro - physiology and radiofrequency ablation, the acknowledgement of AV node and AVNRT incessantly develops deeper. Traditional standpoint shows AVNRT is formed by the reentrance between the double - way of longitudinal separated function inside AV node, but modern electro - physiological measurement and radiofrequency practice both validate that typical ( fast - slow type) AVNRT annulus is not restricted in the AV node, but is composed of two pass way (fast way and slow way) located in the different part among AV node, atrium and AV node, and is also composed of atrial tissue between these two pass way. If radiofrequency ablating the line from coronary sinus open to tricuspid annulus might reduce the junction between cardiac muscle and AV node., we can also cure AVNRT under the condition that slow way may probably be residual. This article discusses the clinical efficacy and security feasibility by adding the use of linear ablation between the upper edge of coronary vein sinus open andtricuspid annulus (CSo -TA) to treat AVNRT.Material and method1. case selection; from 2002 -7 -7 to 2004 -4, 35 cases of DAVNP complicated with SVT treated in our hospital, 13 male, 22 female, aging from 11 to 76 years, for average 49. 2 19. 2 years, tachycardia onset history from 3 months to 40 years. Before ablation, stop all cardiovascular active medicine for more than 5 half life. The patient is with the indication of radiofrequency ablation but without contra - indication.2. electro - physiological examinations: using Seldinger technique to establish two passway of right femoral vein, one passway of left subclavicular vein, send measure electrode to coronary sinus, right ventricle, right atrium, and His branch, synchronized record the surface and intra - cardiac ECG, separately perform atrial and ventricular program S1S2 stimulation, gradually increase S1S2 stimulation to induce tachycardia. In the electro - physiological examination, pay attention to excluding the tachycardia latently conducted through septal bypass way and atrial tachycardia originated from lower position of right atrium. Each case performed isoprenaline exciting test after radiofrequency ablation.3. ablation method: use Cordis Webster 8 F ablating catheter, with temperature of 60 -65Ti or power of 15 -30W. In the procedure of radiofrequency ablation, routinely introduce inferior position method, middle septal method, or posterior position method adding CSo -TA linear ablating method. For some cases , use the long introducing sheath to strengthen catheter stability and tight degree with the vessel.4. result evaluation and statistic analysis: the data is analyzed using SPSS statistical software of version 10.0, and is expressed as mean value 盨D.ResultIn 35 cases of AVNRT, 28 cases use inferior position method, 4 cases use middle septal method, 1 case uses posterior position method, and all cases usethe adding technique of CSo - TA linear ablating method. 35 cases are all successful (among them 21 cases use long sheath) , discharging time 80s -300s, average discharging time 148s 39s, dischargi... |
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