邻近希氏束的快速心律失常的射频消融

目的：探讨邻近希氏束的快速心律失常患者射频消融的策略。方法：对43例邻近希氏束的心动过速患者常规进行电生理检查，明确其机制后采取相应措施进行经导管射频消融术（RFCA）。希氏束旁路的消融在心动过速时进行，而室性心动过速则在窦性心律时消融。记录手术过程、所用器材及并发症发生情况。结果：43例中，10例为希氏束旁路，2例为房性心动过速，30例为房室结折返性心动过速，1例为特发性左心室室性心动过速。首次射频消融成功率为93％(40/43)，复发2例，再次消融均成功。30例使用了Swartz R0鞘管。3例房室结双径路患者消融慢径路时出现一过性房室阻滞。结论：邻近希氏束的心动过速射频消融成功率较高，但有一定的特殊性，应采取不同的消融策略，术中尤需避免损伤希氏束。

Radiofrenquency catheter ablation for tachycardia originating from the site near His bundle

Objective: To explore the strategies of radiofrequency catheter ablation for tachycardia originating from the site near His bundle. Methods: Forty-three patients with tachycardia originating from the site near His bundle received radiofrequency catheter ablation according to the related strategies after determination of the mechanism of tachycardia. The correct site with greatest His bundle potential should be ascertained at first in order not to injure His bundle. The ablation of para-His bundle accessory pathway at tachycardia episode would be optimal, with the ablation of ventricular tachycardia at sinus rhythm. The location of ablation catheter should be carefully monitored using fluoroscopy and the ablation response should also be investigated in time. The procedure process, used apparatuses and complications were recorded. Results: Among the 43 patients, 10 were with para-His bundle accessory pathway, 2 with atrial tachycardia, 30 with atrioventricular nodal (AVN) reentry tachycardia, and 1 with idiopathic left ventricular tachycardia. The first-time ablation successful rate was 93% (40/43) with 2 recurrences, and all the second ablations were successful. Swartz R0 sheaths were used in 30 patients. Transient atrioventricular block was induced during slow pathway ablation in 3 patients with AVN double pathways. Conclusion: The ablation success rate of tachycardia originating from the site near His bundle is still high but with certain characteristics, different strategies should be undertaken, expecially not to injure His bundel.