希氏束旁旁路的射频消融体会

位于希氏束上、下0.5cm以内的右侧间隔旁路称为希氏束旁旁路,为避免射频消融时损伤希氏束,大头导管标测定位应在窦性心律,心室起搏及诱发心动过速三种方式以确定.消融时应密切观察体表QRS波形态及逸搏情况.需在心室起搏下消融时,确信旁路中断后应停止或间歇心室起搏,以观察逸搏情况确定是否希氏束受损.如果自然发作和诱发的室上性心动过速(室上速)均为旁路下传,心内标测为多旁路间折返,房室结构均为旁路者时测不能确认患者房室结传导是否正常,应首先消融其逆传旁路,对正传旁路消融应慎重,以避免消融后的房室传导障碍.

Radiofrequency ablation for Para-Hisian accessory pathways

Para-Hisian accessory pathway (AP) means the AP locate about 0. 5cm above or under the His bundle. To identify the AP location,the big tip catheter mapping must be under sinus rhythm,ventricular pacing and inducing SVT in order to avoid injury of His bundle. During ablation process, the surface morphology and juctional escape rhythm must be observed. If RF must be done under ventricular pacing, once ablating effect is confirmed,the pacing would be stopped and escape rhythm can be observed. If ante-grade condution are always through AP in SVT and endocardial mapping are confirmed multipe APs and AVN are bystander in SVT, we do not exclude abmormal growth in AVN. It can be ablated retrograde AP to treat SVT and should be avoided to ablate antigrade AP.