A型预激综合征射频消融延迟成功一例

导管射频消融术治疗阵发性室上性心动过速的成功率已达到９５％以上,但是仍然有一些心动过速不能由导管射频消融术得到根治。我们遇到１例Ａ型预激综合征２次术中未能消融成功,之后出现延迟成功,报道如下：患者男性,４３岁,有阵发性心悸史８年,无器质性心脏病,心电...     

经左心室侧射频消融B型预激综合征一例

患者男性 ,47岁。主因阵发性胸闷、胸痛 3ｄ ,心电图Ⅱ、Ⅲ、ａＶＦ呈ＱＳ波形在外院怀疑为急性下壁心肌梗死而转我院。入院时体格检查、超声心动图、心脏Ｘ线片和心肌酶正常。根据心电图的δ波形诊断为Ｂ型心室预激 (图 1) ,追问病史 ,既往有阵发性心动过速病史 10年。射频消融术中 ,心室刺激诱发室上性心动过速 ,逆传心房激动于冠状静脉窦口处领先 ,诊断为后间隔显性房室旁路。经右股静脉消融导管于冠状静脉窦开口处 (图 2 )标侧到提前的Ｖ波 (图3Ａ) ,多次放电 ,预激波一过性消失。改行动脉逆行法消融导管进入左心室标测二尖瓣环 ,约 5∶…     

经导管射频消融治疗预激综合征方法学初探

作者采用40MHz的射频对6例预激综合征并阵发性室上性心动过速的患者分别行冠状窦消融和房室结改良术,2例有效。初步认为冠状窦消融有一定局限性。此与射频消融作用局限需精确定位以及旁道远离冠状窦内标测电极有关。用房室结改良术或用吸附电极导管有望提高治疗预激综合征的疗效。     

导管射频消融治疗老年预激综合征

本文报道２３例老年预激综合征（ＷＰＷ）患者导管射频消融（ＲＦＣＡ）阻断旁道（ＡＰ）的临床疗效，采用单极和双极同步记录定位ＡＰ和确定消融靶点，成功阻断所有患者的ＡＰ传导，随访１～２１（１１±６．４）个月无复发。认为ＲＦＣＡ是老年ＷＰＷ患者安全有效的治疗方法。     

左心室侧射频导管消融治疗B型预激综合征1例

患者女性,56岁.“阵发性室上性心动过速”史30余年,心电图示B型预激综合征(图1).入院体检、超声心动描记术和X线胸片无异常.局部麻醉下行电生理检查和射频导管消融术,心室刺激诱发室上性心动过速,逆传心房激动以冠状窦口处最早.经右股静脉消融导管送置右心房,沿右后间隔和冠状窦口标测并消融,未获成功.改行动脉逆行法,消融导管进入左心室标测二尖瓣环,于左后间隔处(距冠状窦口0.5cm)记录到融合的心房和心室波,且心室波较体表心电图预激波提前20ms.25W功率消融1.5s预激波消失(图2),巩固放电60s后心室起搏示室房分离,不再诱发心动过速.     

无逆传的间歇性预激综合征射频消融一例

患者男性 ,36岁 ,阵发性心悸 3年余。常规心电图Ｖ1导联ｄｅｔａｌ波向上 ,Ⅱ、Ⅲ、ａＶＦ导联ｄｅｔａｌ波向下 ,Ⅰ、ａＶＬ导联ｄｅｔａｌ波向上 ,预激波间歇出现 ,初步考虑为间歇性Ａ型预激综合征。心悸时心电图提示心房颤动 (简称房颤 )伴旁道前传。体检、Ｘ线胸片及超声心动图检查未见异常。常规放置电生理检查电极 ,窦性心律 (简称窦律 )下一度可见ｄｅｔａｌ波 ,并于放置右房电极时 ,因导管刺激发生短阵房颤伴旁道下传 ,撤开导管后终止。当各标测导管到位后 ,窦律下未再发现ｄｅｔａｌ波。以大于自身心率 10次频率开始 ,每阵增快频率…     

预激综合征伴房颤射频消融治疗的探讨

目的观察房室旁路射频消融术与房室旁路射频消融联合环肺静脉电隔离术两种消融方法治疗预激综合征伴心房颤动患者的疗效。方法本研究纳入58例预激伴房颤患者,随机分为两组,一组为单纯行房室旁路射频消融术(单纯组)36例,另一组为房室旁路射频消融术联合环肺静脉电隔离术(联合组)22例,术后随访两组患者房颤的复发情况。结果最长随访42个月,最短随访3个月,两组随访期间均无一例患者发生房颤(p>0.05),差异无统计学意义。结论在预激伴房颤患者中,房室旁路射频消融联合环肺静脉电隔离术不优于单纯房室旁路消融术;房室旁路消融术可减少预激伴房颤患者的房颤再发率。     

Characteristics and radiofrequency ablation in posteroseptal and left free-wall subepicardial accessory pathways

Accessory pathways (APs) that can only be ablated from the coronary sinus are likely to be located subepicardially. The electrocardiographic (ECG) and electrophysiological characteristics as well as the immediate radiofrequency ablation success rate and the recurrence rate were compared in 15 patients (11 posteroseptal and 4 left free-wall) with subepicardial APs and in 31 control patients with posteroseptal (15) and left free-wall (16) APs matched with age, sex, and AP location during the same study period in whom APs were successfully ablated from the endocardial approach. Patients with posteroseptal subepicardial APs had a longer tachycardia cycle length (355 +/- 32 vs 286 +/- 49 milliseconds, P < .05), a lower success rate (9 /11 vs 15/15, P = .09), and a higher recurrence rate (3/9 vs 0/15, P < .05) as compared with control patients. A negative delta wave with QS or QR pattern in lead II was present in all 4 patients with a manifest posteroseptal subepicardial AP located in the middle cardiac vein as compared with none of the 5 control patients with posteroseptal APs located in the proximal coronary sinus and 1 of the 9 control patients (P < .01). A positive delta wave in lead I along with an R/S of less than 1 in lead V 1 , and a negative delta wave in lead II, was noted in 1 of the 2 patients with left free-wall subepicardial APs and none of the 7 controls (P = .047). The local activation time is significantly shorter in the 4 patients with left free-wall subepicardial AP than in the 16 control patients (31 +/- 9 vs 89 +/- milliseconds, P = .044). CONCLUSIONS: Some ECG characteristics are suggestive of APs located in the middle cardiac vein and left free-wall subepicardial site, while a longer local activation time is characteristic of left free-wall APs. The success rate is lower and the recurrence rate higher with radiofrequency ablation in patients with subepicardial AP.     

Successful catheter ablation by radiofrequency energy of posteroseptal accessory pathway in a patient with drug refractory Wolff--Parkinson--White syndrome

A 45-year-old patient with the Wolff-Parkinson-White syndromesuffering from recurrent intractable reciprocating atrioventriculartachycardia (RAVT) is reported. He used amiodarone, sotalol,quinidine, propafenone and flecainide unsuccessfully. An electrophysiological study (EPS) performed with four catheterslocalized the site of the anomalous pathway in the ostium ofthe coronary sinus. In this region we could also record a Kentpotential. In the ostium of the coronary sinus, radiofrequencv energy wasrepeatedly applied until the conduction over the accessory pathwaywas abolished both in the anterograde and the retrograde direction.The Kent deflection detectable before ablation, could not bedetected after it. During follow-up (1 month) the patient remainedasymptomatic and the control EPS showed no evidence of pre-excitation,either anterogradely or retrogradely.     

Successful catheter ablation by radiofrequency energy of posteroseptal accessory pathway in a patient with drug refractory Wolff--Parkinson--White syndrome

A 45-year-old patient with the Wolff-Parkinson-White syndromesuffering from recurrent intractable reciprocating atrioventriculartachycardia (RAVT) is reported. He used amiodarone, sotalol,quinidine, propafenone and flecainide unsuccessfully. An electrophysiological study (EPS) performed with four catheterslocalized the site of the anomalous pathway in the ostium ofthe coronary sinus. In this region we could also record a Kentpotential. In the ostium of the coronary sinus, radiofrequencv energy wasrepeatedly applied until the conduction over the accessory pathwaywas abolished both in the anterograde and the retrograde direction.The Kent deflection detectable before ablation, could not bedetected after it. During follow-up (1 month) the patient remainedasymptomatic and the control EPS showed no evidence of pre-excitation,either anterogradely or retrogradely.     

Successful catheter ablation by radiofrequency energy of posteroseptal accessory pathway in a patient with drug refractory Wolff-Parkinson-White syndrome.

A 45-year-old patient with the Wolff-Parkinson-White syndrome suffering from recurrent intractable reciprocating atrioventricular tachycardia (RAVT) is reported. He used amiodarone, sotalol, quinidine, propafenone and flecainide unsuccessfully. An electrophysiological study (EPS) performed with four catheters localized the site of the anomalous pathway in the ostium of the coronary sinus. In this region we could also record a Kent potential. In the ostium of the coronary sinus, radiofrequency energy was repeatedly applied until the conduction over the accessory pathway was abolished both in the anterograde and the retrograde direction. The Kent deflection detectable before ablation, could not be detected after it. During follow-up (1 month) the patient remained asymptomatic and the control EPS showed no evidence of pre-excitation, either anterogradely or retrogradely.     

预激综合征患者发生心房颤动的危险因素及射频导管消融房室旁路后的远期预后

目的 分析预激综合征伴心房颤动（房颤）患者的危险因素,研究射频导管消融房室旁路对房颤复发的影响。方法 639例行射频消融术的预激综合征患者,对可能发生房颤的危险因素和消融房室旁路后房颤复发的影响因素进行分析。结果 82例(12.8％)有房颤,557例无房颤。预激综合征伴房颤组男性、高龄、多旁路者更多。对成功消融房室旁路...     

经桡动脉射频消融术治疗特发性左心室室性心动过速

目的探讨经桡动脉途径射频消融治疗特发性左心室室性心动过速（ILVT）的可行性和安全性。方法选择20例Allen试验为阳性的ILVT患者（A组）,采用桡动脉穿刺置入6F长鞘作为5F消融导管进入途径,经锁骨下静脉穿刺置入6F动脉鞘并插入右心室电极导管作为局部记录和心室刺激或同时插入冠状静脉窦电极导管作为局部记录和心房刺激,将其结果与另外20例经股动脉途径进行射频消融的ILVT患者（B组）比较。结果A组20例患者均成功经桡动脉插入鞘管和消融导管,平均放电（6．04-2．1）s终止心动过速。A组的消融术时间和X线曝光时间分别为（53．7±9．2）min和（10．7±1．9）min,明显短于B组（64．6±11．1）min和（14．7±2．5）min（P〈0．05）。两组患者放电次数、消融能量和放电时间差异无统计学意义。A组患者术后顺利拔除消融导管和鞘管,患者均无穿刺部位并发症,平均随访（8．9±5．2）个月无复发,穿刺手臂活动正常。B组有1例患者发生穿刺部位血肿。结论经桡动脉途径射频消融治疗ILVT可行且安全有效。     

Is radiofrequency ablation of accessory pathways always necessary?: The case of a variant of Wolff-Parkinson-White syndrome

A 16-year-old boy was referred for radiofrequency ablation of an accessory pathway. He had not experienced palpitations, but a normal electrocardiogram was a prerequisite for enrolment in a professional soccer school. The electrocardiogram showed a PR interval of 0.10 second and wide QRS complexes suggestive of an accessory pathway. The case of a variant of Wolff-Parkinson-White syndrome is discussed.     

Successful sequential radiofrequency catheter ablation of anatomically discrete antegrade and retrograde accessory pathway conduction in the Wolff-Parkinson-White syndrome.

Histopathologically, accessory atrioventricular (AV) pathways comprise tiny strands of working myocardium that traverse the AV groove and link between the atrial and ventricular myocardium. Antegrade and retrograde conduction in bidirectional accessory pathways have generally been considered to occur along the same fibers. This report details the successful catheter ablation of a left free wall accessory pathway with radiofrequency energy. Antegrade and retrograde conduction of the pathway were abolished sequentially by separate episodes of energy delivered at anatomically discrete though closely adjacent sites along the mitral annulus. This finding raises the interesting possibility of anatomic "compartmentalization" of antegrade and retrograde conduction along an accessory pathway.     

单导管射频消蚀预激综合征患者的左侧旁路

以单导管法对3例体表心电图有delta波的预激综合征患者行射频消蚀。据心电图定位旁路后,将一根消蚀导管经右股动脉插入左室,在二尖瓣环左室侧标测到旁路电位后以该导管放电,全部成功。平均放电5次,平均操作时程1.3小时。本观察提示,单导管是消蚀部分显性预激患者房室旁路的简便、安全和有效的方法。