永存左上腔静脉并发室上性心动过速的射频消融治疗

目的:探讨永存左上腔静脉（PLSVC）并发室上性心动过速（SVT）的射频消融策略。方法: 2008年6月～2011年6月在我科行射频消融的SVT患者1 460例， 17例并发PLSVC。其中房室结折返性心动过速（AVNRT)8例，左侧隐匿性旁路伴房室折返性心动过速（AVRT）6例，阵发性房颤（PAF）3例。结果: 17例患者均经左锁骨下静脉穿刺成功，并放置冠状窦电极，8例AVNRT患者经房室结改良成功；6例左侧隐匿性旁路，4例经主动脉逆行途径消融，2例经房间隔穿刺，在二尖瓣心房侧进行旁路消融；3例PAF患者行房间隔穿刺后行环肺静脉电隔离。消融成功率100%，无手术并发症。结论: PLSVC并发SVT，导管消融治疗仍有较高的手术成功率和较低的手术并发症，但在左锁骨下静脉穿刺的识别、导管消融的技巧及手术并发症的防治方面仍有其特殊性。

Radiofrequency catheter ablation of superior ventricular tachycardia in patients with persistent left superior vena cava

AIM: To discuss the strategy of radiofrequency catheter ablation(RFCA) of superior ventricular tachycardia(SVT) in patients with persistent left superior vena cava(PLSVC).METHODS: From June 2008 to June 2011,17 patients with PLSVC and SVT underwent RFCA,including AV node modification(eight patients),left accessory pathway(six patients) and paroxysmal atrial fibrillation(three patients).RESULTS: Coronary sinus was accessed through left subclavian vein in all 17 cases.AV node modification was performed in eight patients.Four patients with left-side accessory pathway were ablated through aortic retrograde approach and the other two patients with left-side accessory pathway were ablated through transseptal approach.Three patients with PAF were ablated through circumferential pulmonary vein isolation after atrium septum puncture.The success rate was 100% and no complications occurred.CONCLUSION: Despite the high success rate and low complication rate of RFCA for patients with PLSVC and SVT,special attention should be paid to the puncture of PLSVA,performance of ablation and prevention of complications.