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頁籤選單縮合
題名 | 心臟快速不整脈的高頻波電燒灼治療 |
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作者姓名(中文) | 林俊立; | 書刊名 | 內科學誌 |
卷期 | 5:1 1994.03[民83.03] |
頁次 | 頁3-22 |
分類號 | 415.318 |
關鍵詞 | 快速不整脈; 迴旋頻脈; 高頻波電燒灼術; 電生理定位; Supraventricular tachycardia; Reentry tachycardia; Radiofrequency catheter ablation; Electrophysiologic mapping; |
語文 | 中文(Chinese) |
中文摘要 | 心臟的快速不整脈,傳統上均訴諸藥物治療,萬非得已才藉開心手術 來加以控制,俾預防其潛伏危險性。近年來,由於運用精密的定位觀念,配合易 操縱之高頻波能源,已能針對多種上心室性,乃至心室性快速不整脈,或頻脈, 加以近乎治癒性的處置。高頻波能量經由電極導管傳送,僅造成小局部的心肌傷 害,因此治療的成功必須仰賴精密定位,訊號分析,以搜尋快速不整脈的源頭, 或者迴旋途徑的弱點。Wolff-Parkinson-White氏症候群的關鍵位置在於多餘的房 室聯接道,定位上以記錄到不正常的過早心房或心窒電氣活動,不正常的房室直 接聯通,或者特別的局部脈波,來指示房室聯接道位置。房室結迴旋頻脈的形成, 主賴房室結快、慢二通道的搭配;其迴旋途徑的關鍵即在於快通道與慢通道的功 能。目前,運用房室結結構及相關迴旋通道的新知,安全的電燒灼點已知在於冠 狀靜脈竇開口與房室結之間,亦即房室結慢通道之所在。以上兩種最普遍之上心 室性頻脈,依此定位對策,均已有95-99的成功治癒率,且鮮少併發症。至於心 房撲動與心室頻脈兩種源自心肌壁的快速不整脈,主要病因均已知是迴旋性機轉; 其定位則是運用頻脈進行時的心內壁的系統性搜尋,目標則為心舒中期局部脈 波,前心縮期局部脈波,以及利用"暫時性電刺激帶動加速"測得之頻脈起源點。 目前心房撲動、右心室頻脈之療效較佳,但對左心室者尚有待努力。此外,異位 性心房頻脈此種自動性增強所致之少數快速不整脈,也已能定點燒除。結合快速 不整脈發生前、中、後的心臟各位置電氣訊號分析,吾等已能精密地運用經導管 所輸送之高頻波能量,徹底燒除許多快速不整脈的病因,治癒此一痛疾。 |
英文摘要 | Electrophysiologic mechanism of the majority of clinical supraventricular and ventriculartachyarrhythmia isreentry. To eliminate the tachycardia, a critical strike at the reentrant circuit is necessary. The application oftranscatheter radiofrequency energy at the strategic site of the circuit has successfully eradicated many of thepotentially life-threatening arrhythmia.Determination of the critical weaklink of the tachycardia circuit requires systematic delineation of total activation sequence, but also functional verification of the isthmus area, suitable for the heating ablation by radiofrequency energy. ForWolff-Parkinson-White syndrome, the target to attack is the accessory atrioventricular(AV) pathway. Identification of the insertion position by precise recording of specific accessory pathwaypotential and eccentric local AV or VA activation fusion resulted in the overall 95-98 success rate by radiofrequency catheter ablation. For AV nodal reentrant tachycardia, the target was focused at the presumedanatomical location oftheAV nodal slow pathway. It had also had nearly 100 elimination of the tachycardiaon short-and longterm follow up. As to type I atrial flutter and sustained monomorphic ventricular tachycardia, the concept of transient entrainment by overdrive pacing enables the verification of the slow conductionisthmus by the derivative analysis of the orthodromic versus antidromic local capture, the earliest postpacingrecovery, and the middiastolic local activation. Radiofrequency ablation on such site could eradicate the tworeentranttachycardia. Even fortachycardia of automaticity mechanism, i.e. ectopic atrial tachycardia, curative catheter ablation can be done by detailed search of the site of origin.In conclusion, with the combination of new energy source and critical analysis of electrical signals duringvarious tachycardias, the elimination of many troublesome tachyarrhythmias has become possible. (J InternMed ROC 1994: 5: 3-22.) |
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