利用单极标测在心房颤动时消融显性房室旁道

对12例预激综合征患者在心房颤动时以单极标测指导消融房室旁道，其中左侧显性旁道9例、右侧显性旁道3例。在消融成功的靶点图上，单极标测的心室激动较体表心电图QRS波群显示预激成分最明显的Delta波平均提前46±7ms。全部病例消融成功。平均随访7．9±5．1个月，除1例右侧旁道4个月后恢复旁道前向传导需再次消融外，其余11例常规和动态心电图既未见Delta波，也无房室折返性心动过速和心房颤动发生。结果提示对于心房颤动合并显性房室旁道的患者，采用单极标测，其图形易于迅速辨认、测量方法亦简单，用以指导消融成功率高。

Radiofrequency Catheter Ablation of Manifest Accessory Pathways With Unipolar Recording During Atrial Fibrillation

Radiofrequency catheter ablation of manifest accessory pathways was performed with unipolar recordingduring atrial fibrillation in patients with Wolff-Parkinson-White syndrome. There were 12 patients with a mean ageof 43±15 years. Ten patients had manifest left-sided accessory pathways and three had manifest right-sided acces-sory pathways. On the unipolar electrogram of successful sites,the mean time interval of ventricular activation frornthe intrinsic deflecation to the delta wave of the maximally preexited QRS complex in the surface electrocardiogramwas 46±7 ms. All 12 patients were successfully treated with catheter ablation. During a mean follow-up period of7.9± 5. 1 months,only one patient with a right-sided accessory pathway had a recurrence of anterograde conduction4 months after ablation and underwent the second successful radio frequency ablation. None of tbe other 11 patientshad evidence for anterograde accessory pathway conduction and episodes of atrioventricular reentrant tachycardlaand atrial fibrillation in the surface and 24 h ambulatory electrocardiogram. The results suggest that radiofrequencycatheter ablation of accessory pathways with tlnipolar Fecording during atrial fibrillation is highly effective. Therecording of unipolar electrogram can be recognized quickly and measurement of local activation times can be madesimply during atrial fibrllation.