左侧斜行旁道心腔内心电图特征及射频导管消融

目的 探讨快速、准确标测左侧斜行旁道消融靶点的方法，提高导管消融成功率。方法 对66例AVRT患者在高位右心房刺激、心室刺激或室性期前收缩、诱发室上性心动过速及窦性心律时进行心腔内电生理检查，确定旁道的走行方向，标测心室及心房侧靶点图，记录消融靶点位置及消融时间。结果 发现6例旁道走行方向斜跨二尖瓣环并确定为斜行旁道，经主动脉逆行法最终全部消融成功，部分病例耗时较长。结论 如果冠状窦标测电极(CS)记录到的最早逆行心房激动点和最早顺传心室激动点不在同一记录直线上，在排除多旁道后应考虑斜行旁道的可能，同时可判断其斜行程度。最早逆行心房激动点和最早顺传心室激动点分别是心房侧和心室侧的消融靶点。如能标测到旁道电位，成功率更高。对于隐匿性左侧旁道，左心室起搏信号s到cs上最早逆传至A波的最短间隔处是很好的消融靶点。

Characteristics of intracardiac electrogram of left oblique atrioventricular accessory pathways and radiofrequency catheter ablation

Objective To find way for ablation target of left oblique atrioventricular accessory pathways quickly and accuratly in order to improving success possibilities. Methods Patients were under some intracardiac electrophysiological study following circumstances: stimuli at high right atrium,stimuli at ventricle or ventricular extrasystole,inducing paroxysmal supraventricular tachycardia and at sinus rhythm.Then ensured whether they were oblique atrioventricular accessory pathways and level of accessory pathways.Then marked up target graphs of ventricle and atrium side.At last recorded the of ablation target and time. Results Six cases of oblique atrioventricular accessory pathways were successfully ablated finally.But some of them took too much time. Conclusion If earliest atrial activation(EAA)and earliest ventricular activation(EVA)that recorded during coronary sinus electrode are not at same record line,then it can be ensured oblique atrioventricular accessory pathways. Meanwhile we can judge level of accessory pathways EAA and EVA are separately ablation target of atrium side and ventricle side .If accessory pathways potential can be marked up, success possibilities may be higher .