预激综合征患者多旁路的射频消融

１７４例预激综合征患者中１３例（７．５％）具有多旁路（２９条）。２９条旁路中２１条由基础电生理检查证实，８条在阻断其它旁路后显现。４例在双侧，９例在单侧消融。平均放电３２±１４次后将２７条（９３．１％）旁路阻断。多旁路与单旁路消融成功率相似（９３．１％ＶＳ９４．０％，Ｐ＞０．０５）；但放电次数多（３２±１４ＶＳ１４±１１，Ｐ＜０．０５），消融时程长（３．６±０．８ｈＶＳ２．１±０．９ｈ，Ｐ＜０．０１）；多旁路组复发率高（７．６％ＶＳ１．９％，Ｐ＜０．０１）．本研究证实射频消融是根治多旁路患者的有效方法。

Radiofrequency Catheter Ablation of Multiple Atrioventricular Accessory Pathways

Among the 174 patients with tachycardia mediated by an atrioventricular(AV) accessory pathway and treated by radiofrequency catheter ablation, thirteen(7.5%)were with multiple accessory pathways, Twenty one of the total 29 pathways were identified during the baseline electrophysiologic study and the other 8 pathways were discovered after the elimination of initial ones by the ablation. The posteroseptal plus right free wall pathway was the most commonly (61.5%)observed in the multiple pathways group. Bilateral ablation was used in 4 cases and in other 9 patients,single side approach was attempted.Twenty-seven pathways( 93.1%)were abolished permantently. Compared with the single pathway ablation,the success rate was identical(93.1%VS 94.0%,P>0. 05). However,the pulses of current delivery and procedure time required by multiple pathways ablation were more(P<0. 01)and the recurrence rate in multiple pathways group was higher(7.6%VS 1.9%,P<0.01). It is concluded that most of the multiple accessory pathways coule be found by detailed electrophysiologic study. The radiofrequency catheter ablation could be a safe and effective method for the therapy of the special patients population.