Koch三角的电生理指数及X线解剖在慢径消融中的应用

对 2 7例房室结双径路并折返性心动过速病人行慢径消融术时 ,用His束和冠状窦导管分别标记Koch三角底部和顶端 ,X线投照用左前斜 45°和右前斜 30°分别测量Koch三角的高度并以 2 0mm为界分为大小Koch三角两组 ,观察成功和不成功靶点的位置 ,采用测量冠状窦口A波至His束H波 (Acso H)传导时间和冠状窦口A波至靶点A波的传导时间 (Acso AT) ,以及Acso H/Acso AT为电生理指标 ,观察成功和不成功靶点的差异。结果 :成功靶点在小Koch三角组多在冠状窦口上缘 5mm水平以下 ,大Koch三角组位置较高可达Koch三角中下 1 / 3处。其电生理指标以Acso AT为 5 .78± 1 .2ms说明靶点激动时间略晚于冠状窦口 ,Acso H/Acso AT比值大于 1 2 .2± 4 .5亦可反映靶点远离His束而接近冠状窦口。对大小不同的Koch三角 ,X线影像和电生理学的量化指标结合 ,可作为靶点定位的参考指标

The Electrophysiologic Parameter and Anatomy in X-ray for Koch''''s Triangle in Ablation of Slow Pathway

Twenty-seven patients with atrioventricular node reentry tachycardia were performed ablation of slow pathways.The base and top of Koch′s triangle were m arked with catheter electrodes of His bundle and coronary sinus ostium(CSO).The highness of Koch′s triangle were measured in X-ray exposure in left anterior o blique 45 ° and right anterior oblique 30 ° and divided two groups by 20 m m hi gh in order to evaluate the sites of successful and unsuccessful targets.The con ducting time from CSO to His bundle(Acso-H) and from CSO to A wave of target(Ac so-AT) were measured and to calculate the ratio of Acso-H/Acso-AT to observe differences in two groups.The successful targets located below 5 mm in upper mar gin of CSO in small Koch′s triangle group but the targets located up to inferio r 1/3 site of Koch′s triangle in larger triangle group.Acso-AT is more than 5. 78 ms in successful group,suggest that the activity of the targets are later tha n CSO.Acso-H/Acso-AT is more than 10 in successful targets and suggest that it can be reflected the distance from His bundle to CSO.The quantitative parameter of combination of electrophysiology and Koch′s triangle size in x-ray can be useful in ablation of slow pathways.