左侧房室旁道射频消融中特殊心电现象与处理对策

目的报道24例左侧房室旁道射频消融的特殊心电现象与处理对策。方法1例左后侧壁显性房室旁道经心内膜标测和消融不成功,改冠状静脉窦标测和消融,术中冠状静脉窦造影了解其结构。2例射频消融后旁道呈间歇性逆传,采用心室RS2刺激法进行标测与消融。6例冠状窦电极显示激动的先后顺序不明显,其中1例消融导管在二尖瓣环心室侧和心房侧均未标测到满意靶点图,多次试放电失败,最终在左中间隔消融;另5例消融导管在明显高于冠状窦电极的部位才标侧到满意靶图。10例消融导管在二尖瓣环心室侧始终未标测到满意靶点图,或反复消融仅能一过性阻断旁道,改动脉途径逆行法心房侧消融。7例心室起搏下消融不成功而采用窦性心律下放电。结果全部病例消融成功。结论极少数左侧房室旁道由于其特殊的电生理现象往往需采用不同的标测和消融策略。

Special Electrophysiology Phenomena and Countermeasures during Radiofrequency Catheter Ablation in Patients with Left-sided Accessory Pathways

Objective To discuss the special electrophysiology phenomena and Countermeasures strategy in the radiofrequency ablation of left-sided accessory pathways with 24 cases.Methods Mapping and ablation were carried out in coronary sinus in one case manifesting left posterolateral accessory pathway after the endocardial approach had failed.Coronary sinus angiography was performed to evaluated its anatomic feature.In 2 cases retrograde conduction of AP recurred intermittently after ablation then mapping and ablation were carried out during the ventricular RS2 extrastimulus.Coronary sinus activation sequence was no remarkable difference in 6 cases.In one case routine mapping on both ventricular and atrial sides of the mitral valve annulus found no satisfactory target point and ablation failed for many times.At last the effective target site was located in left midseptal area.Ablation on the atrial side of mitral valve annulus succeeded in 10 cases using retrograde aortic approach after mapping on the ventricular side was unsuccessful or the AP conduction could only be blocked transiently.7 cases underwent RFCA during the sinus rhythm after failure in ventricular pacing.Result The Radiofrequency ablation were successful in all cases.Conclusion Different mapping and ablation strategy should be used in some left-sided AP cases with special electrophysiology phenomena.