经上腔静脉途径射频消融右侧前上和前间隔房室旁道

报道经上腔静脉途径射频消融右侧前上和前间隔房室旁道的体会。 13例右侧前上或前间隔单一房室旁道患者 ,常规下腔静脉途径消融未能成功 ,失败原因包括 :消融电极与心肌接触不良或难以固定于三尖瓣环上。改经上腔静脉途径成功消融阻断所有房室旁道。平均放电 1.8± 0 .7次 ,输出功率 33± 4W ,消融靶点电图振幅明显高于下腔静脉途径 (1.4± 0 .3mVvs 0 .6± 0 .4mV ,P <0 .0 5 )。术后随访 17± 9个月 ,无 1例复发。作者认为对经下腔静脉途径消融失败的右侧前上和前间隔房室旁道采用上腔静脉途径消融可获得成功。

RadiofrequencyCatheter Ablation of Right Anterior and Anteroseptal Atrioventricular Accessory Pathway bySuperior Vena Cava Approach.

This paper is to report the experience and results of radiofrequency ablation for right anterior and anteroseptal atrioventricular accessory pathway by the superior vena cava approach.Radiofrequency ablation by routine inferior vena cava approach for thirteen patients with single right anterior or anteroseptal atrioventricular accessory pathway was failed.The factors of unsuccessful ablation included poor electrode tissue contact or difficult to place the catheter tip on the tricuspid anulus seurely.However,all of these accessory pathways were successfully ablated by using the superior vena cava approach with a mean radiofrequency application 1.8±0.7 and radiofrequency energy 33±4 W.The amplitude of local electrogram at target site was significantly higher in superior vena cava approach than that in the inferior vena cava approach(1.4±0.3 vs 0.6±0.4 mV,P<0.05).No recurrence of accessory pathway conduction was found during a mean follow up of 17±9 months.It suggests that using the superior vena cava approach can successfully ablate the right anterior and anteroseptal atrioventricular accessory pathways that are failed by inferior vena cava approach.