右侧显性房室旁道合并右后隔慢旁道的电生理特点和消融治疗

报道两例右侧显性房室旁道合并右后隔慢旁道的电生理特点和消融治疗。两例显性预激综合征接受射频消融治疗 ,心房和心室程控刺激评价消融前后电生理变化。心脏标测证实两例病人存在右侧显性房室旁道 ,阻断该旁道后AV间期延长达 16 3和 16 7ms,QRS波群变宽呈完全预激形 ,程控刺激和标测证实为右后隔慢旁道 ,前传速度慢但无递减传导 ,无VA传导 (例 1)或VA递减传导 (例 2 )。消融阻断慢旁道后AV再次延长达 188ms和 2 17ms,心室预激消失 ,QRS波群呈右束支阻滞形 ,心室刺激见VA分离。结论 :两例病人为右侧游离壁显性房室旁道合并右后隔慢旁道 ,前者掩盖后者的前向传导。正常房室传导束 (AVN HPS)的传导速度慢于慢旁道是其显现前传的原因。

TheElectrocardiophysiologic Study and Ablation Treatment of Patients With Right-Free-WallManifest Accessory Pathway Complicated Right Septal Slow Accessory Pathway

This paper reports electrocardiophysiologic features and ablation treatment of two patients with right free wall manifest accessory pathway (AP) complicated right septal slow AP.During rediofrequency catheter ablation,two patients with Wolff Parkinson White syndrome were studied through atrial and ventricular programmed stimulation in order to evaluate electrocardiophysiologic changes before and after ablation of AP.Results:Two patients had right free wall manifest AP during cardiac mapping,after ablation of the APs their AV intervals were prolonged to 163 and 167 ms and QRSs were widen to full preexcitation complex.Programmed stimulation and mapping confirmed that another manifest AP was located at right septal area in two patients.The APs had slow but no decremental AV conduction,no VA conduction in one patient and VA decremental conduction in another patient.After ablation of septal AP,the AV intervals were prolonged up to 188 and 217 ms,ventricular preexcitation were disappeared,QRSs changed to right bound bronch block form,and VA dissociation were found during ventricular stimulation in two patients.Conclusion:It was concluded that two patients had manifest right free wall and septal slow APs.Right free wall AP covered AV conduction of septal slow AP.Because the normal AV conduction (AVN HPS) was slower than the septal slow APs,the septal slow APs could appear their AV conduction.