直视下心外膜导管射频消融右侧房室旁路

目的对右侧房室旁路合并需要进行外科手术治疗的心脏病患者，或多次心内膜导管射频消融治疗失败者，探讨采用直视下心外膜导管射频消融法阻断房室旁路传导的可能性。方法３例右侧显性房室旁路，２例为男性慢性风湿性二尖瓣病变，术前经多家医院心内膜导管射频消融术治疗均未成功，旁路分别位于右房室环９点和７点处；１例为女性先天性心脏病室间隔缺损，术前未经导管射频消融治疗，体表心电图定位旁路位于右侧前壁。手术中于右房和右室外膜各缝扎一根２极导管用于双极记录和刺激，手执四极大头电极导管沿右侧房室沟从室间隔处经右游离壁到冠状静脉窦口或反向进行标测，在理想的标测靶点处放电消融。结果３例患者的３条旁路均一次消融成功，没有心房穿孔或右冠状动脉损伤等并发症，旁路阻断时间１～２ｓ，总操作时间１０～２０ｍｉｎ，术后随访６～１２个月无心动过速复发。结论对右侧房室旁路合并需要进行手术治疗的心脏病患者或多次心内膜导管射频消融治疗失败者，可考虑采用心外膜导管射频消融的方法进行治疗。

Epicardial radiofrequency catheter ablation during open heart surgery in patients with right atrioventricular accessory pathway

Objective In order to explore the feasibility of using a new right accessory pathway (RAP) ablation method,epicardial radiofrequency catheter ablation (ERCA),to replace the previous cutting ablation during open heart surgery,three patients with arrhythmogenic right free wall accessory pathway (RAP) and organic heart disease were treated with this method. Methods The ERCA procedure was completed before extracorporeal circulation.Two bipolar electrodes were sewed on the right atrial and ventricular epicardium respectively as stimulating or recording electrode pair.A largetip electrode catheter was handled by the operator to map the right tricuspid ring from epicardium.Ablation target point was determined by analysing the characteristics of the epicardial electrogram same as that of the endocardial approach.T5HZResultsBZAll three RAPs were ablated in 12 seconds by 1015 Watts energy delivery with total procedure time 1020 minutes.There were no complications such as atrial perforation and right coronary artery injury.RAP recurrence was not found in 612 month followup. Conclusion ERCA could be used in open heart surgery to ablate the arrhythmogenic right atrioventricular accessory pathway for patients complicating with organic heart disease treatable by surgery and those patients having been treated unsucessfully with endocardial radiofrequency catheter ablation by several experienced cardiologists.