特殊左侧房室旁路的射频导管消融策略

目的探讨特殊左侧旁路射频导管消融中的策略。方法行射频消融手术治疗房室旁路引起的房室折返性心动过速合并永存左上腔静脉患者3例,其中男性2例,女性1例,年龄51、42和48岁。经主动脉逆行途径在二尖瓣心室侧、穿间隔途径在二尖瓣心房侧行射频消融。随访4~12个月,观察患者有无室上性心动过速复发及心电图检查有无显性旁路恢复。结果具有一定特殊性左侧旁路的3例患者均消融成功,手术成功率100%,无并发症发生。3例患者合并永存左上腔静脉,其中1例经房间隔穿刺途径在二尖瓣心房侧消融时出现迷走神经反射,心率、血压下降,广泛导联ST-T改变,经冠状动脉造影证实非冠状动脉病变,为完全性左束支传导阻滞。术后随访4~12个月,3例患者均无室上性心动过速发作。结论左侧房室旁路导管射频消融存在特殊情况时,需仔细鉴别,通过不同的方法及途径消融,仍可获得较高的成功率。

Strategy of radiofrequency catheter ablation in special left accessory pathway

Objective To explore the strategy of radiofrequency catheter ablation in special left accessory pathway. Methods A total of 3 patients with the special left accessory pathway combined with persistent left superior vena cava were enrolled, which included 2 males（aged 51-year-old and 42-year-old） and 1 female（aged 48-year-old）. All the patients were performed radiofrequency ablation through aortic retrograde approach. After 4- 12 months follow-up, the superventricular tachycardia（SVT）recurrence and dominance pathway in electrocardiogram（ECG） were observed. Results All the patients with special left pathway were ablated successfully, the success rate was 100 %, and no complications occurred. The 3 patients combined with persistent left superior vena cava, 1 case showed the heart rate and blood pressure decrease in persistent left superior cave during ablation. ST-T changing in ECG was confirmed without coronary artery disease and considered left bundle branch block. After 4- 12 month followed-up, SVT was not recurrence and ECG was normal in 3 patients. Conclusion It is demonstrated that the ablation in special left accessory pathway, should be carefully identified by different methods, and it could achieve high success rate.