心房颤动时显性房室旁道的射频消融治疗

对 2 6例预激综合征患者于心房颤动 (简称房颤 )时射频消融显性房室旁道。其中左侧旁道 9例、右侧旁道17例 ,2 2例有阵发性房颤史。房颤发作伴旁道前传时的心室率为 171± 32 ( 132～ 2 37)bpm。采用经主动脉逆行法或穿间隔法消融左侧旁道、经股静脉途径消融右侧旁道 ,以最早心室前向激动点且有小A波处为消融靶点。房颤时成功消融靶点的V波较体表心电图预激波的起点提前 37.2± 8.1( 2 6～ 5 3)ms。放电 6± 3( 1～ 16 )次后 ,2 6例中有2 5例 ( 96 % )旁道前传被阻断 ,1例失败。阻断旁道前传后 30min ,3例自行恢复窦性心律 ,2 2例经直流电复律后恢复窦性心律 ,心室起搏示 2 5例中有 2 3例旁道逆传已被阻断 ,2例仍存在 ,经继续消融获得成功。随访 19.2± 11.7( 1～ 38)个月 ,除 1例复发正向前传型房室折返性心动过速 (O AVRT) ,经再次消融旁道逆传成功外 ,其他患者无O AVRT发作及旁道前传恢复的证据。结论 :心房颤动时射频消融显性房室旁道方法可行、成功率高

Radiofrequency Catheter Ablation of Manifest Accessory Pathways During Atrial Fibrillation

Radiofrequency catheter ablation of manifest accessory pathways (APs) were performed during atrial fibrillation in 26 patients (leftsided APs in nine patients and rightsided APs in 17 patients) with WolffParkinsonWhite syndrome. Of them,22 patients had a history of paroxysmal atrial fibrillation.The mean ventricular rate druing atrial fibrillation with rapid anterograde conduction over the accessory pathways was 171±32 bpm (range 132 to 237 bpm).Leftsided APs were targeted either via retrograde aortic or transseptal approach.Rightsided APs were ablated with a 7F or 8F deflectable (4 mm tip) catheter which introduced from femoral vein.The electrogram characteristics of the ablated target sites included earliest ventricular activation in relation to the onset of preexitation in the surface electrocardiogram and small atrial potential.At the successful ablation sites,local ventricular activation during atrial fibrillation showed 37.2±8.1 ms (range 26 to 53 ms) before the onset of preexcitation in the surface electrocardiogram.Anterograde accessory pathway conduction was successfully ablated during atrial fibrillation in 25(96%) patients with a mean of 6±3 (range 1 to 16) radiofrequency applications.30 minites later,sinus rhythm was restored spontaneously in three patients and after an electrical cardioversion in other 22 patients.Retrograde block of the APs was confirmed by ventricular pacing in all but two patients,in which a successful secondary ablation was achieved.During a mean followup period of 19.2±9.7 months (range 1 to 38),none had evidence of anterograde accessory pathway conduction,but only 1 patient had recurrence of orthodomic atrioventricular reentry tachycardia,which was abolished by a second ablation.Conclusion:Radiofrequency catheter ablation of manifest accessory pathway during atrial fibrillation is feasible with a high success rate.Chinese Journal of Cardiac Pacing and Electrophysiology,2000,14(2):104～106] Atrial fibrillation Atrioventricular pathway,manifest Catheter ablation,radiofrequency current