室上性心动过速射频消融疑难病例分析

目的：分析６例特殊疑难射频消融病例,探讨安全有效的消融策略。方法：３例为右侧旁道,其中１例为右侧显性旁道,术中导管机械刺激诱发心房颤动,采用单极标测消融成功．另２例为右侧隐匿性旁道,采用“窦－室－窦”标测法,于窦律下放电阻断旁道。２例左侧隐匿性旁道,其中１例为房室折返性心动过速伴终止时长时间窦性停搏,反复晕厥,即“快一慢”型室上性心律失常,射频消融后,其伴随症状也消失．另１例为左后间隔隐匿性慢传导旁道,测△ＨＡ为３２ｍｓ,得以确诊。１例为慢一快型房室结折返性心动过速,胸廓畸形,心血管严重移位．导管操作困难。结果：所有患者均消融成功。结论：特殊类型疑难病例消融成功的关键是,根据各自特殊的电生理和解剖特点,采取针对性消融策略。

ANALYSIS OF RADIOFREQUENCY CATHETER ABLATION FOR UNUSUAL DUFFICULT CASES OF SUPRAVENTRICULAR TACHYCARDIA

Objective: To analyze six unusual difficult cases in 130 patients of radiofrequency catheter ablation(RFCA) for supraventricular tachycardia, and to assess safe approaches and effective procedures. Methods: Three cases had right-sided accessory pathways(AP). One of them was manifest. It was induced atrial fibrillation with mechanical stimulation of catheter in the operation. RFCA success was achieved with unipolar mapping. The other two were obscure so we usedes 11 sinus-ventricular-sinus" mapping and discharged in the sinus rhythm to discontinue AP. Two cases had left-sided AP. One of them was atrioventricular reentrant tachycardia (AVRT) with long sinus pause and fainted repeatedly. Alter RFCA, the following symptoms disappeared. The other was left in posterioseptum AP because his △HA was 32ms. The last case was solwfast atrioventricular node reentrant tachycardia (AVNRT) complicated with deformity chest and cardiovascular, so we operated the catheter difficultly. ResultS: All the ablation procrdures were successful. Conclusions: The key to RFCA in unusual type cases is to take special tactics according to each patient's Fharacteristic of eletrophysiology and anatomic structure.