二十极Halo导管标测三尖瓣环指导右侧旁路消融  

Ablation of Right-sided Accessory Pathways Guided by Mapping of Tricuspid Valve Annular Using 20-pole Halo Catheter

作　　者：王业松[1] 冯冲[1] 唐安丽[1] 何建桂[1] 柳俊[1] 王礼春[1] 董吁钢[1] 

机构地区：[1]中山大学附属第一医院心血管内科,广东广州510080

出　　处：《中山大学学报（医学科学版）》2010年第3期432-435,共4页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省科技计划项目(2008B080703020)

摘　　要：【目的】探讨20极Halo导管置于冠状窦,同步标测二尖瓣环和三尖瓣环是否可以指导右侧旁路导管消融。【方法】分别放置希氏束电极、右室电极和Halo电极。Halo导管置入冠状窦,同步标测二尖瓣环和三尖瓣环。在心室起搏或顺向性心动过速识别最佳室房(V-A)融合和最早心房激动,或在窦性心律识别最佳房室(A-V)融合和最早心室激动。【结果】16条旁路由Halo电极和希氏束电极准确识别:5条位于右后间隔,3条位于右前间隔,8条位于右侧游离壁。消融导管在相应位置快速标测和记录到最佳V-A融合和最早心房激动或最佳A-V融合和最早心室激动。所有旁路均消融成功。平均程序时间为(58±18)min,X线曝光时间(26±8)min。随访(26±18)月未见并发症和复发。【结论】置于冠状窦和三尖瓣环Halo电极和希氏束电极可以快速确定右侧旁路的位置,指导成功消融,缩短程序时间和X线曝光时间。【Objective】To investigate whether a 20-pole Halo catheter inserted into the coronary sinus（CS）to simultaneously map mitral valve annulus and the tricuspid valve annulus（TVA）could guide the catheter ablation of right accessory pathway（AP）.【Methods】Two 4-pole catheters were positioned in His bundle area and right ventricle,respectively,and a Halo poles was inserted into the CS to simultaneously map mitral valve annulus and the TVA.The accessory pathway location was identified using the sites of optimal ventricular-atrial（V-A）fusion and earliest atrial activation during ventricular pacing or orthodromic tachycardia,or the sites of optimal atrial-ventricular（A-V）fusion and earliest ventricular activation during sinus rhythm.【Results】Sixteen AP locations were correctly identified by the Halo poles and the His bundle poles in the following positions：right posteroseptal 5,right anteroseptal 3,and right free wall 8,where the ablation catheter rapidly maped and recorded the optimal V-A fusion and the earliest atrial activation,or the optimal A-V fusion and the earliest ventricular activation.All APs were successfully ablated.Mean procedure time was（58±18）min,and fluoroscopy time was（26±8）min.There were no complications and recurrences during（26±18）months follow-up.【Conclusion】A Halo poles positioned at the CS and the TVA and a His bundle poles can rapidly locate right-sided AP,guide successful ablation and shorten procedure time and fluoroscopy time.

关 键 词：旁路 标测 导管消融 

分 类 号：R541.7[医药卫生—心血管疾病]