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。     

经冠状窦憩室行房室旁路射频消融三例

经冠状窦憩室行房室旁路射频消融三例商丽华杨新春胡大一国外文献已有冠状静脉血管畸形的报道［１］，并且证实部分后间隔旁路与冠状窦憩室等血管畸形有密切关系［２～４］。本文报告国内３例因射频消融后间隔显性旁路遇到困难，经冠状动脉造影证实有冠状窦憩室及心中静脉...     

心外膜旁路的识别和射频消融治疗

目的　报道左侧心外膜旁路的特点和经冠状静脉窦射频消融术的结果。　方法　 5例左侧旁路患者先经心内膜标测和消融 ,由于不成功改由经冠状静脉窦标测 (左心室心外膜标测 ) ,记录到旁路电位即进行消融。　结果　 5例患者全部成功 ,成功消融靶点 :左侧游离壁 2例 ,左后间隔冠状静脉窦憩室 3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。　结论　冠状静脉内标测到振幅较大的旁路电位是左侧心外膜旁路的重要标志 ;经冠状静脉窦消融可以有效的阻断心外膜旁路     

冠状静脉形态与左侧旁路关系的研究

目的 :观察冠状静脉形态与左侧旁路的关系。　　方法 :6 7例左侧游离壁旁路和后间隔旁路的患者在旁路成功射频导管消融后行冠状静脉窦逆行显影 ,测量射频导管消融靶点距冠状静脉分支开口的距离 ,小于 5 mm认为二者相关。　　结果 :全部 6 7例成功的进行了冠状静脉造影 ,5 7例 (85 .1% )旁路位于冠状静脉分支开口处 ,4例位于冠状静脉狭窄或扩张处。　　结论 :左侧旁路与冠状静脉形态具有一定相关性     

经冠状静脉窦射频导管消融房室旁路的疗效和安全性

目的 :探讨经冠状静脉窦低能量射频导管消融房室旁路的适应证、疗效和安全性。　　方法 :2 2例左侧房室旁路患者先经心内膜射频导管消融 ,不成功改由经冠状静脉窦标测途径。　　结果 :2 2例患者全部成功 ,17例 (77.3% )成功靶点与冠状静脉分支或畸形有关。 15例有效靶点记录到振幅较大的房室旁路电位 ,其振幅于 A波和 V波之比大于 1,前传 V波和逆传 A波较心内膜标测分别提前 2 6 .1± 5 .1m s和 2 2 .5±9.2 m s。　　结论 :低能量冠状静脉窦射频导管消融可以安全、有效的阻断房室旁路。     

左后间隔旁道并冠状静脉窦憩室行射频消融一例

患者男性,46岁,因"阵发性心悸5年"入院。入院后诊断:A型预激综合征伴顺向型房室折返性心动过速,心内电生理示左后间隔旁道,冠状静脉窦造影示冠状静脉窦憩室。于冠状静脉窦憩室颈部标测到理想靶点放电后阻断心外膜房室旁道,体表心电图delta波消失,心室刺激显示室房分离,术后4周未发生心动过速。     

三条房室旁路并休眠旁路的心内电生理检查及导管射频消融治疗一例

3条房室旁路患者临床中非常少见 ,同时合并休眠旁路者更少。本文报道 1例 3条房室旁路并休眠旁路的心内电生理检查及导管射频消融治疗。　　病例资料　患者女性 ,2 0岁。阵发性心悸病史 6年。常规检查未发现器质性心脏病。窦性心律心电图示预激综合征 (图 1)。射频消融术中常规放置导线电极于冠状静脉窦、右心室心尖部以及高位右心房。程序刺激后诱发顺向性和逆向性房室折返性心动过速 ,以及短暂心房扑动和心房颤动伴旁路前传。消融导线电极经右股动脉置于二尖瓣环下 ,距冠状静脉窦口 1 5ｃｍ处标测窦性心律时ＡＶ最近 ,右心室刺激标测逆传…     

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…     

以冠状静脉窦壁心肌为心房插入点的后间隔旁路

目的介绍５例经导管标测和射频消融证实的以冠状静脉窦（ＣＳ）壁心肌为心房插入点的后间隔旁路。方法常规电生理检查定位旁路在后间隔,以７Ｆ大头导管标测左、右后间隔和二尖瓣环左心房侧（房间隔穿刺）,均找不到比ＣＳ电极处更理想的标测电图,多次高能量消融不成功。经右心房将大头电极送至ＣＳ口或ＣＳ内,标测到典型靶点图,低能量消融成功。结果５例患者男性３例,女性２例,年龄３８±１７岁。旁路以ＣＳ口１ｃｍ内为插入点者３例,２ｃｍ内者２例。心动过速中放电３例,右室起搏时放电２例,能量１０～２０Ｗ,旁路均在２ｓ内阻断。随访１４±６个月无心动过速复发。结论ＣＳ壁全程都可成为房室旁路的心房插入点。这种旁路走行偏心外膜,如果在左、右后间隔心内膜难以有效标测和消融,应仔细标测ＣＳ壁,准确定位后以低能量或温控方式在ＣＳ壁上消融。     

以冠状静脉窦壁心肌为心房插入点的后间隔旁路

后间隔旁路是心脏房室旁路中变异较大的一类，对其中一些较为特殊的类型在导管射频消融治疗中难以进行标测和定位，其原因是后间隔部位较为复杂的解剖结构使旁路心房端插入点的变异程度增大。本组介绍5例经导管标测和消融证实的以冠状静脉窦壁心肌为心房插入点的后间隔旁路。     

Radiofrequency catheter ablation of a concealed atrioventricular accessory pathway associated with a coronary sinus diverticulum

A 31-year-old woman underwent radiofrequency catheter ablation of a concealed left posteroseptal accessory pathway associated with a coronary sinus diverticulum. The patient had previously undergone unsuccessful catheter ablation of the posteroseptal region of the mitral annulus. Coronary sinus venography revealed the presence of the diverticulum near the ostium. An electrogram in the neck of the diverticulum showed the shortest ventriculoatrial conduction time and a large accessory pathway potential during atrioventricular reciprocating tachycardia. The pathway was successfully ablated within the neck of the diverticulum. The findings in this case underscore the importance of coronary sinus venography before ablation.     

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     

Coronary sinus diverticulum with a concealed posteroseptal accessory pathway: a red herring?

A 21-year-old male presented with episodes of paroxysmal tachycardia mediated via a concealed posteroseptal accessory pathway. He was also found to have a diverticulum of the coronary sinus. However, successful radiofrequency ablation was achieved only endocardially under the mitral annulus and not within the diverticulum.     

A posteroseptal accessory pathway located in a coronary sinus aneurysm: diagnosis and radiofrequency catheter ablation

A coronary sinus aneurysm was diagnosed by means of echocardiography, coronary sinus contrast angiography, coronary angiography, and nuclear magnetic resonance imaging in a patient with Wolff-Parkinson-White syndrome caused by a posteroseptal accessory pathway. Percutaneous radiofrequency current catheter ablation performed in the isthmus of the coronary sinus aneurysm was successful.     

A posteroseptal accessory pathway located in a coronary sinus aneurysm: diagnosis and radiofrequency catheter ablation

A coronary sinus aneurysm was diagnosed by means of echocardiography, coronary sinus contrast angiography, coronary angiography, and nuclear magnetic resonance imaging in a patient with Wolff-Parkinson-White syndrome caused by a posteroseptal accessory pathway. Percutaneous radiofrequency current catheter ablation performed in the isthmus of the coronary sinus aneurysm was successful.     

A posteroseptal accessory pathway located in a coronary sinus aneurysm: diagnosis and radiofrequency catheter ablation.

A coronary sinus aneurysm was diagnosed by means of echocardiography, coronary sinus contrast angiography, coronary angiography, and nuclear magnetic resonance imaging in a patient with Wolff-Parkinson-White syndrome caused by a posteroseptal accessory pathway. Percutaneous radiofrequency current catheter ablation performed in the isthmus of the coronary sinus aneurysm was successful.     

Catheter ablation of septal accessory conduction pathways with high frequency electric current]

In 58 symptomatic patients with septal accessory atrioventricular pathways, attempts at catheter ablation of the pathway were made using 500-kHz radiofrequency current. The methodological approach (introduction and final positioning of the ablation catheter) was dependent on the anatomical site of the accessory pathway. Right anteroseptal pathways were accessed via a jugular venous route, whereas a femoral venous route was used for right mid- and posteroseptal pathways. In these pathways, ablation was attempted from an atrial catheter position. Left posteroseptal pathways were located via mapping of the coronary sinus and were ablated either from the left ventricle or (in 3 cases) from the vena cordis media. Utilizing a deflectable catheter with a 4-mm tip electrode, ablation attempts were successful in 54 patients (93%) with a median of 12 radiofrequency current pulses of an average 24.9 W of power and 23.2 s length. The mean duration of the sessions was 4.6 h. Impairment of physiological conduction (first-degree AV block) was observed in 1 patient; complete heart block was never induced. Recurrences after initially successful ablation necessitated a repeat session in 2 patients. One patient died 3 days after successful ablation of a posteroseptal accessory pathway. Septal accessory pathways may be ablated using radiofrequency current with an efficacy and safety comparable to free-wall accessory pathways and with good preservation of physiological AV node-His bundle conduction.     

Radiofrequency catheter ablation of septal accessory pathways

Catheter ablation of septal accessory pathways in preexcitation syndrome is associated with special problems because of the risk of impairment of atrioventricular nodal conduction during ablation of anteroseptal and midseptal pathways. The complex morphology of the posteroseptal space has special problems for ablation with unclear location of the ablation catheter in the left or right atrial or ventricular cavum, in the coronary sinus, ventricular veins, or the neck of a coronary sinus diverticulum. Therefore, the visualization of the pyramidal space using echocardiographic investigations before the ablation procedure and retrograde coronary sinus phlebography during the ablation session has proven to be very helpful in placement of the electrode to the successful position. Reported herein are the techniques, results, and problems of radiofrequency ablation of 30 patients with septal accessory pathways compared to published data.