冠状静脉内导管射频消融治疗后间隔心外膜房室旁道的临床研究(附17例报告)

对 17例后间隔旁道的体表心电图特征、电生理特性及导管射频消融术方法学进行分析和探讨。男 11例、女6例 ,年龄 41± 2 4(11～ 73)岁。与后间隔心内膜旁道相比 ,后间隔心外膜旁道的体表心电图有其自身的特点。 17例患者 ,射频消融成功 16例 ,成功率 94%。 7例在冠状静脉窦内消融成功 ,8例在心中静脉内消融成功 ,1例在冠状静脉窦巨大憩室颈部消融成功 ,1例未成功。 17例手术时间 140± 87(86～ 180 )min ,X线曝光时间 42± 2 9(30～ 6 6 )min。 16例随访 1～ 2 4个月 ,无一例心动过速复发。结论 :在冠状静脉内消融成功的后间隔旁道具有一些特定的体表心电图特征。常规在左右侧间隔部标测无满意靶点且试放电无效时 ,应考虑为后间隔心外膜旁道 ,在冠状静脉内标测消融具有较高的成功率 ,能明显缩短手术时间和X线曝光时间 ,无并发症。

Radiofrequency Catheter Ablation of Epicardial Posterior Septal Accessory Atrioventricular Pathways in Coronary Vein.

The results of radiofrequency catheter ablation (RFCA) of 17 cases of epicardial posterior septal accessory atrioventricular pathways in coronary vein were analyzed with the surface ECG,electrophysiologic characteristics and the RFCA methodology.Results:16 of the 17 cases were successfully blocked by RFCA (success rate 94%),including 7 cases blocked in the coronary sinus,8 cases in the median cardiac vein and 1 case at the neck of huge diverticulum of the coronary sinus.1 case failed.The mean procedure time was 140±87(86～180) min and the mean fluorcopy time was 42±29(30～66) min.No one reoccurred tachycardia in successful cases during the follow up of 1～24 months.Conclusion:The posterior septal pathways which can be successfully ablated in the coronary vein have certain characteristics in surface electrocardigram.When the routine mapping of left and right septum finds no satisfactory target point,mapping and abaltion in the coronary vein may have a higher success rate,shorter operation time and exposure time to X ray.There were no complications in our study.