常见心律失常的射频消融——预激综合征房室旁路的射频消融

房室旁路是室上性心动过速中最常见射频消融治疗的内容之一 ,目前已经有比较成熟的方法。但迄今开展的旁路射频消融术中仍存在盲目消融、不成功消融、消融后房室传导阻滞及心包填塞等问题。因此 ,规范其方法学仍十分必要。1　左侧旁路1.1　左侧旁路部位的标测　消融术前规范的电生理检查和精确的旁路定位仍是十分重要的内容 ,其中冠状静脉窦和希氏束导管的定位必不可少 ,这对于确定旁道是否参与心动过速、确信消融结果和避免希氏束损伤都是必要的。冠状静脉窦导管标测对左侧旁路部位的确定起着十分重要的作用 ,但由于旁路在心室和心房的附着…     

预激综合征右侧间隔旁路射频消融的体会

右侧间隔旁路中以希氏束上、下０．５ｃｍ以内的旁路射频消融时易产生希氏束损伤及影响房室传导，应密切观察消融过程中的结性逸搏，及时观察Ｐ－Ｒ间期变化，以避免并发房室传导障碍。     

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。     

预激综合征左侧多旁路的电生理特点及射频消融

预激综合征多旁路是诱发多种形态心动过速尤其诱发心房颤动的常见原因 [1] 。由于其心动过速发作时可通过多种折返径路 ,与单旁路相比具有更为复杂的电生理特征 ,故临床诊断及射频消融靶点较困难 [1,2 ,3] 。 1 995年以来 ,我们对 1 2例预激综合征左侧多旁路患者进行射频消融治疗 ,均获成功。现报告如下。1　资料与方法1 .1　一般资料　同期行旁路射频消融 2 2 0例 ,其中1 2例为左侧多旁路 ,男、女各 6例 ,年龄 3 5～ 5 5岁 ,均有反复发作心动过速史。术前仅 4例可提供有 2种形态心动过速的体表心电图 ,均为顺向和逆向折返型 ,体表心电图无…     

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。     

预激旁路射频消融术后复发因素分析

预激旁路射频消融术后复发因素分析解放军总医院心内科单兆亮综述王玉堂王思让审校１９８７年，Ｂｏｒｇｇｒｅｆｅ等［１］首次报告利用射频能量成功消融人的预激旁路。此后，由于可操纵的大头消融电极的出现以及其他消融方法的使用，经导管射频技术快速发展起来，日趋成...     

Radiofrequency Catheter Ablation of Accessory Pathways:

RF Catheter Ablation of APs. Catheter ablation techniques are now advocated as the first line of therapy for arrhythmias caused by accessory pathways (APs). The most common energy source is radiofrequency current, but technical characteristics vary. Several parameters can be used to determine the optimal target site: AP potential, AV time, atrial or ventricular insertion site, or unipolar morphology. Specific considerations are needed depending on AP location. Despite the different approaches described, there is no significant difference in the reported success rate, which is over 90%. However, the number of radiofrequency applications needed to achieve ablation appears to differ significantly, with median values from 3 to 8 reported. A combination of criteria related to both timing and direction of the activation wave-front or use of subthreshold stimulation could improve the accuracy of mapping. In patients with "resistant" APs, different changes in ablation technique must be considered during the procedure to achieve elimination of AP conduction. The incidence of complications in multi-center reports is close to 4%, with a recurrence rate of 8%. The long-term safety of catheter ablation requires further study.     

Radiofrequency Catheter Ablation of Three Accessory Pathways in a Single Session

Radiofrequency Ablation of Multiple Accessory Pathways. A 19-year-old patient is described having three accessory atrioventricular pathways. All three pathways were ablated using radiofrequency current in a single electrophysiologic investigation. (J Cardiovasc Electrophysiol, Vol. 3, pp. 141–149, April 1992)     

经冠状静脉窦射频消融心外膜旁道

报道 13例左侧心外膜旁道的特点和经冠状静脉窦射频消融的结果。 13例左侧旁道患者先经心内膜标测和消融 ,如不成功改由经冠状静脉窦标测 ,记录到旁道电位或最早激动的V波或逆传A波即进行消融。结果 :13例患者全部成功 ,平均放电 1.5± 0 .6次 ,能量 2 1± 4W ,时间 2 1± 9s。成功消融靶点 :左侧游离壁 2例、左后间隔冠状静脉窦憩室 4例、心中静脉 7例。 11例有效靶点均标测到振幅较大的旁路电位 ,其振幅大于A波和V波 ,与二者之比均大于 1。结论 :冠状静脉窦标测到振幅较大的旁道电位是左侧心外膜旁道的重要标志 ;冠状静脉窦消融可以有效地阻断心外膜侧旁道     

经冠状静脉窦标测和消融后间隔心外膜房室旁道

报道心外膜房室旁道的特点和经冠状静脉窦射频消融术的结果。3例后间隔显性房室旁道患者先经心内膜标测和消融,不成功后改由经冠状静脉窦内标测和消融。术中冠状动脉造影,观察冠状静脉窦形态。结果: 2例冠状静脉窦近端有一憩室,并在憩室的颈部消融阻断房室旁道。成功靶点图为标测到振幅较大的旁道电位,其振幅大于A波和V波。结论:经心内膜标测和消融失败的旁道可能是心外膜旁道,行冠状静脉窦内标测与消融可有效阻断旁道,冠状静脉窦憩室与后间隔旁道可能存在着解剖关系。     

Safety and Efficacy of Outpatient Transseptal Radiofrequency Ablation of Atrioventricular Accessory Pathways

A retrospective analysis of 60 consecutive patients who underwent outpatient transseptal radiofrequency ablation of left sided accessory pathways at Westchester County Medical Center/New York Medical College from September 1994 to December 1997 was performed. Patients were followed for a mean duration of 22 months. No complications either local or related to the transseptal method were observed. All patients had successful ablation of the accessory pathway. One patient had a recurrence of symptoms. This study suggests transseptal radiofrequency ablation of the left sided accessory pathways to be safe, feasible and an effective procedure when performed in an outpatient setting. These results were obtained at a high volume center with experience using the transseptal technique.     

Radiofrequency Ablation of Atrial Insertion of Left-Sided Accessory Pathways Guided by the "W Sign"

AP Ablation and the "W Sign." introduction: The aim of this study was to evaluate the efficacy of radiofrequency (RF) ablation of the atrial insertion of left-sided aceessory pathways with guidance by a specific morphologic characteristic of the local electrogram, which we call the "W sign." This represents the shortest local atrioventricular (AV) interval during sinus rhythm in patients with manifest preexcitation or the shortest local VA interval during AV reciprocating tachycardia and/or ventricular pacing in patients with concealed accessory pathways.
Methods and Results: The transseptal technique was used in 31 patients (18 men, 13 women; aged 32 ± 13 years), and RF ablation of 33 accessory pathways (26 manifest and 7 concealed) was attempted. Patients presented with palpitations (n = 16), presyncope (n = 10), or syncope (n = 5). The clinical arrhythmia was AV reciprocating tachycardia (n = 24) or atrial fibrillation (n = 7). In 21 patients (68%) electrophysiologic study and RF ablation were performed at a single session. Accessory pathways were left posteroseptal (n = 5) or left free wall (n = 28). The "W sign," formed from merging of the local atrial and ventricular electrograms, was identified at all successful sites prior to ablation. Ablation was successful in all patients. A median of 7 RF lesions were delivered per patient. The fluoroscopy time was 76 ± 48 minutes; total procedure time was 5.4 ± 1.9 hours. No significant complications occurred. Early recurrence (≤ 24 hours) occurred in I patient; during 6 ± 4 months, accessory pathway conduction recurred in another patient.
Conclusion: We conclude that RF ablation of the atrial insertion of left accessory pathways can be very successful when guided by the "W sign."     

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。     

The Experience of Radiofrequency Ablation for Treatment of Multiple Accessory Pathways

Objective To analyse retrospectively the experience of radiofrequency ablation for successful treatment of multiple accessory pathways (APS). Methods 150 patients with supraventricu-lar tachycardia related to APS have undergone radiofrequency ablation since 1994; the data was analysed. Results 8 patients with multiple APS were cured, 4 patients could be diagnosed to have multiple APS during electrophysiologic study (EPS) before ablation, and in the remaining 4 patients the multiple APS could only be diagnosed after successful ablation of one AP. Conclusion right - sided multiple APS are sometimes very difficult to treat by ablation, because there are no standard reference electrograms for bracketing the earliest site. Mapping area should be broader rather than limited by preestablished idea.     

射频消融治疗预激综合征失败病例分析

以射频消融３０７例预激综合征患者，２４例未成功，前、中、后各百例内失败者各占１４，６和４例，成功率分别为８６％、９４％和９６．４％（１０３／１０７）．９例行二次消融成功。初期消融失败的主要原因为导管操作不熟练和旁路定位不精细。中、后期则主要原因为未准确识别某些特殊部位如后间隔及右游离壁旁路的局部电图特征。表明操作者的经验与成功率密切相关。     

导管射频消融右侧房室旁道的回顾性分析

对连续接受导管射频消融的５４例右侧旁道病人进行回顾分析,试图总结实用有效的常规消融方法。５４例中右游离壁旁道２８例、右前间隔９例、右中间隔５例、右后间隔１２例。１００％消融成功,无并发症。随访７．５±３．８个月,术后２４ｈ复发３例,３个月复发１例,均再次消融成功。右游离壁和右前间隔旁道较右中间隔和右后间隔旁道心室波提前程度大（２６．６±１４．２和２１．４±１０．７ｍｓｖｓ１６．３±１８．５和１４．５±１１．８ｍｓ,Ｐ＜０．０５）,消融能量高（４３．３±５．４和３７．８±９．２Ｗｖｓ２１．４±７．１和２６．７±５．７Ｗ,Ｐ＜０．０５）,Ａ、Ｖ波比值较小。中间隔和后间隔旁道较游离壁和前间隔旁道心房波振幅高（１．０±０．３和０．９±０．６ｍＶｖｓ０．５±０．４和０．６±０．３ｍＶ,Ｐ＜０．０５）,导管较稳定。旁道在１ｓ内阻断者心室波提前程度、心房波振幅、导管稳定性和消融能量与旁道在５ｓ以上阻断者比较,差异有显著性（Ｐ＜０．０５）,而且旁道阻断时间越短者,其心室波提前程度越大、心房波振幅越高,Ａ、Ｖ波比值越大,导管越稳定。提示影响右侧显性房室旁道消融成功率的主要因素是导管操作者的经验和对靶点图的识别,这些涉及到对消?