右侧壁房室旁道再次射频消融成功的体会

右侧壁是右侧房室旁道导管射频消融（ＲＦＣＡ）较困难区域。对６例ＲＦＣＡ失败和（或）复发的右侧壁房室旁道再次消融成功进行分析，以探讨其消融的方法学。选用８Ｆ加硬大头或温控导管，部分病例使用Ｓｗａｒｔｚ鞘辅助操作，均经静脉途径于三尖瓣环上进行消融。６例患者术中均成功阻断旁道，有效放电１１次、射频电流功率平均４３±６（３０～５０）Ｗ、放电时间平均３７９±８１（２７０～４８０）ｓ，与５０例右侧其它部位旁道消融功率（平均３６±４Ｗ）和时间（平均２４０±２３ｓ）分别相比，Ｐ均＜０．０５。５例患者随访期间停用抗心律失常药物，无心动过速发作；１例术后１６ｈ再次复发。体会：采用高功率、长时间放电可取得一定疗效；常规选用加硬导管，部分使用温控导管，辅以适当的Ｓｗａｒｔｚ鞘管和提高导管操作技巧等有助于提高右侧壁旁道ＲＦＣＡ的成功率。

Successful Experience on Repeat Ablation of Right Lateral Atrioventricular Accessory Pathway With Radiofrequency Current

Right lateral wall is a more difficult region in treatment of right atrioventricular accessory pathway(AP) by radiofrequency catheter ablation(RFCA).This article analyzed the feature of RFCA in 6 tough cases with right lateral AP in order to evaluate the methology of RFCA.A Braided or temperature guided ablation catheter was placed above tricuspid anulus through femural vein.All patients were ablated successfully,the time of effective discharge was 11,the power of radiofrequency current ranged from 30 to 50 walts(43±6 walts),the duration of delivery ranged from 270 to 480 seconds(379±81 seconds),which were much more than those in control group (36±4 walts,240±23 seconds,respectively, P <0.05).During following up,5 pateitns were free from any kind of tachyarrhythmias on no medicine and 1 patient had recurrence of preexcitation.The results indicated that the more energy and longer time delivery of radiofrequency current were needed to completely abolish the AP conducton,the skilled operation and the use of Braided catheter,temperature guided catheter and Swartz guiding sheath could improve the success rate.