经主动脉逆行至二尖瓣环房侧消融左侧房室旁路的方法学探讨

目的:探讨经主动脉逆行至二尖瓣环房侧消融左侧旁路的可行性。方法:左侧旁路消融病例159例,消融导管均经主动脉逆行置入,于二尖瓣环房侧或室侧进行消融。根据消融部位分组,记录手术时间、曝光时间、放电功率、放电次数等参数,并进行对比研究。结果:所有病例均获得了手术成功,其中2例首次消融后复发,而接受了再次手术,故共完成了161次手术,消融了165条左侧旁路。其中109条旁路(66.1%)于房侧消融成功。比较房侧及室侧消融病例各项参数,前者最大放电功率大于后者(P<0.01),而手术时间、曝光时间及放电次数均差异无统计学意义(P>0.05)。2例复发病例首次手术时均于室侧消融,再次手术时于房侧消融,未再复发。结论:经主动脉逆行至二尖瓣环房侧消融左侧旁路这一方法可提高左侧旁路消融成功率及降低复发率,并在多数情况下可取代经房间隔穿刺消融的方法。

Investigation of the methodology of ablating left atrioventricular accessory pathway at the atrial side of mitral annuli through the transaortic approach

Objective:To investigate the feasibility of improving the methodology of ablating left atrioventricular accessory pathway(AP)at the atrial side of mitral annuli through the transaortic approach in order to improve the utility value of this method.Method:There were 159 patients who all had undergone the operation of radiofrequency catheter ablation accomplished by the author and cooperators last year in this study.Electrophysiologic study was performed in a routine procedure.After a left AP was identified,the ablating catheter was introduced transaorticly in every patient.Ablation was given at the atrial and/or ventricular side of mitral annuli.All patient were grouped according to the ablating site.These parameters including the operating duration(min),fluoroscopy time(min),the highest power of RF current pulse(W)and the number of pulses were recorded and a comparative study was made retrospectively.Result:Successful ablations were obtained in all cases,and 2 of them had recurrence of symptom and underwent the second procedure successfully.Thus there were 161 procedures having been accomplished and 165 APs(including a double-AP existing in 4 pts)ablated in all,109 of which were ablated at atrial side eventually.Comparing every parameter between the group of ablating at atrial side and that of at ventricular side,it could be found that only the highest power of RF current pulse was significatively higher than the former(P<0.01),but concerning the operating duration,fluoroscopy time and the number of pulse there were no apparent differences(P>0.05).In the two recurrent cases,both of the first ablation was done at the ventricular side and the atrial side was selected as ablation target in the second procedure with no more recurrence.Conclusion:With the methodology improving and the experience accumulating,these problems such as difficulty in manipulating the catheter and unstable contact between the catheter tip and the endocardium encountered during ablating left AP at the atrial side of mitral annuli through the transaortic approach could be resolved,and therefore the practical value of this method could be raised,which would be helpful for enhancing the success rate and decreasing postoperative recurrence of ablating left AP.Moreover,transseptal procedure could be avoided in most cases.