三尖瓣环下心室侧途径对常规射频消融失败的右侧房室旁路的消融治疗

目的评估三尖瓣环下心室侧消融在常规射频消融失败的右侧房室旁路中的有效性和安全性。方法入选2016年4月至2018年4月在武汉亚洲心脏病医院心内科曾消融失败和/或消融后复发的9例右侧房室旁路患者进行回顾性研究,所有患者均应用Carto三维标测系统标测,且均于三尖瓣环下心室侧进行标测消融。结果所有9例患者均即刻消融成功,其旁路分布分别为三尖瓣环后侧游离壁5例、希氏束旁2例、三尖瓣环侧壁2例。术中放电消融(4.4±0.8)次,放电消融过程中旁路阻断时间为(6.5±1.3)s,所有患者术中旁路均同时达到双向阻滞。随访(28.4±15.6)个月无心动过速复发和/或旁路传导恢复,围术期及随访期间无并发症出现。结论三尖瓣环下心室侧消融右侧房室旁路是安全有效的,可增加导管的稳定贴靠,尤其是对于消融失败或复发病例效果明显。

Ablation treatment right-sided accessory pathways with failed by conventional radiofrequency ablation

Objective To evaluate the efficacy and safety of under-valve approach to ablate right-sided accessory pathways(RAP)failed by conventional radiofrequency ablation.Methods Nine patients with RAP were enrolled,who had previously failed with conventional radiofrequency ablation from April 2016 to April 2018 in Department of Cardiology of Wuhan Asia Heart Hospital.Three-dimensional electroanatomic mapping was performed and with the help of a long sheath,the undervalve approach was attempted in all patients.Results All the 9 patients were ablated successfully immediately.The distribution of the accessory pathway in these 9 pathways was as follows:5 posterolateral,2 para-Hisian,2 lateral.The mean number of radiofrequency ablation applications was 4.4±0.8,and the mean time from the ablation start to accessory pathways(AP)conduction block was(6.5±1.3)s.Bidirectional AP conduction block was the end point at the same site under the tricuspid valve.Patients were free of tachycardia or recurrence of AP conduction during a median follow-up of(28.4±15.6)months.No complications were found during the procedure or follow-up period.Conclusion Radiofrequency ablation under the tricuspid valve to eliminate RAP is safe and effective because of its stable contact and the accurate ablation of the ventricular insertion site.