预激综合征患者经射频导管消融阻断房室旁路术后房室旁路显性传导短暂恢复的处理思路

目的：探讨预激综合征（WPW）患者经射频导管消融（RFCA）阻断房室旁路（AP）术后，数小时内AP短暂恢复房室显性传导的处理策略。方法：回顾性分析连续1378例接受RFCA治疗成功的持续性WPW患者，剔除间歇性WPW和RFCA失败患者。记录分析所有患者的临床资料、电生理检查结果、病情转归及随访情况。结果：依据RFCA术后结果将1378例WPW患者分为3组。1356例直接取得成功（直接成功组），8例患者术后WPW短暂恢复房室显性传导（WPW短暂恢复组），14例RFCA术后WPW复发（WPW复发组）。WPW短暂恢复组与直接成功组的消融靶点局部心室电位提前体表ECG的QRS起始时间无统计学差异[（27±9）ms vs．（28±6）111S]，但WPW复发组显著短于直接成功组[（23±9）ms vs．（28±6）ms，P〈0．05]。WPW复发组的消融放电开始至WPW消失时间显著长于另外两组[（12±6）SVS．（5±3）S，（6±3）S，P〈0．05]。WPW短暂恢复组8例患者的AP分别于右后间隔消融成功2例、右游离壁3例、左后间隔1例及左游离壁2例。WPW首次恢复均发生在术后24h内，并均于术后24h内WPW再次消失。WPW短暂恢复组的WPW首次复发和持续时间均显著短于WPW复发组[（9±5）hw．（56±38）d，P〈0．05]和[（12±6）h掷．≥72h，P〈0．05）。WPW短暂恢复组中的5例患者于术后72h以后接受了再次电生理检查，证实已消融的AP前向和逆向传导功能均已被成功阻断；另外3例患者选择了临床观察。经随访6个月以上，该8例患者WPW未再复发亦无室上性心动过速发生。结论：WPW患者经RFCA后出现WPW短暂恢复的患者，可继续观察，若WPW再次消失，可临床随访，无需再次行电生理检查及射频消融术。

Treatment strategy of accessory atrioventricular pathway transient recurrence in patients with preexcitation syndrome after radiofrequency catheter ablation

AIM： To investigate the characteristics and treatment strategy of accessory atrioventricular pathway （AP） transient recurrence in patients with preexcitation syndrome （WPW） after radiofrequency catheter ablation （RFCA）. METHODS： We included 1378 WPW patients who underwent successful RFCA. Those patients with intermittent WPW or unsuccessful RFCA were excluded. Clinical data, electrophysiological study results, clinical results and follow-up information were analyzed. RESULTS： According to RFCA results, 1 378 patients were divided into three groups. There were 1356 patients with successful RFCA and were classified according to the direct successful group. Eight patients with transient recurrence of AP conduction after RFCA were divided into transient recurrence group, and 14 patients with persistent recurrence of AP conduction were classified as recurrence group. Durations of local ventricular electrogram of ablation site preceded the onset of QRS without statistical difference between transient recurrence group and direct successful group [ （27 ＋ 9 ） ms vs. （28 _＋ 6） ms ], but these time intervals were significantly shorter in recurrence group than direct successful group [ （23 ＋ 9 ） ms vs. （28 _＋ 6 ） ms, P 〈 0.05 ]. The time from delivering radiofrequency energy to disappearance of surface ECG preexcitation wave was longer in the recurrence group than in the other two groups [ （ 12 ＋ 6） s vs. （5 ＋ 3 ） s （6 -＋ 3） sec, P 〈 0. 05 ]. The successful RFCA sites of AP were located at the right posterior septum （ n = 2）, right free wall （ n = 3 ）, left posterior septum （ n = 1 ） and left free wall （ n = 2 ） in transient recurrence group. WPW relapsed and re-disappeared within 24 h after RFCA in transient recurrence group. The recurrence time and recurrence lasting time were both shorter in transient recurrence group than in recurrence group [ （9 ＋5） h vs. （56 _＋38） day, P 〈0. 05 and （ 12 _＋6） h vs. 72 h, P 〈0.05~. Five of the eight patients with transient recurrence accepted a second EP study 72 h after RFCA, and EP study confirmed that the AP were eliminated successfully. After 〉 6 months follow-up, the eight patients had no WPW and tachycardia recurrence. CONCLUSION： Those cases with transient recurrence of AP antegrade conduction after RFCA of WPW syndrome should be observed for several days. If the pre-excitation wave spontaneously disappears, it is unnecessary to again perform EP study.