射频导管消融治疗伴发于Ebstein畸形的房室折返性心动过速  

Radiofrequency Ablation of Atrioventricular Reciprocating Tachycardia in Patients With Ebsteins Anomaly

作　　者：姚焰[1] 王方正[1] 张奎俊[1] 马坚[1] 华伟[1] 田瑞国[1] 朱克平[1] 鲁志民[1] 孙瑞龙[1] 陈新[1] 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院临床电生理研究室

出　　处：《中国循环杂志》1999年第2期94-95,共2页Chinese Circulation Journal

摘　　要：目的：为治疗伴发于Ｅｂｓｔｅｉｎ畸形的阵发性室上性心动过速，我们对４例患者进行了射频导管消融。方法：４例伴发于Ｅｂｓｔｅｉｎ畸形的阵发性室上性心动过速患者，年龄２５～３４岁，药物治疗效果不佳或不能耐受，遂进行电生理检查和射频导管消融。结果：４例患者经心内电生理检查均证实为右侧旁路房室折返性心动过速。理想的消融靶点位于房室环、心内ＡＶ波大致相等处，其ＡＶ波间距较长。全部患者的射频导管消融均获成功。结论：射频导管消融通过阻断右侧旁路而治愈伴发于Ｅｂｓｔｅｉｎ畸形的室上性心动过速。正确认识其解剖和电生理特点，是消融成功的关键。附图射频导管消融治疗Ｅｂｓｔｅｉｎ畸形的旁路心内电生理图。图ａ：射频导管消融靶点图，消融导管远端（ＬＡＢｄ）所描记到的ＡＶ波振幅基本相等并有距离，在此进行消融。图ｂ：射频导管消融成功后ＡＶ间距明显增大。ＨＢＥ：希氏束电图ＲＶＡ１～２：右心室心尖部ＣＳ１～１０：冠状静脉窦ＣＳ９～１０：冠状静脉窦近端ＣＳ１～２：冠状静脉窦远端ＬＡＢｐ：消融电极近端３讨论Ｅｂｓｔｅｉｎ畸形是最常伴有预激综合征的先天性心脏病（可达１６．１％），且有１２．９％的患者有阵发性室上性心动过速［１］；与心动过速有关的晕厥及?Objective:To cure the refractory supraventricular tachycardia associated with Ebsteins anomaly. Methods:We performed electrophysiologic study and radiofrequency ablation in four patients (age 25 34 years old) with Ebsteins anomaly and supraventricualr tachycardia,which were refractory to the drug therapies. Results:Orthodromic atrioventricular reciprocating tachycardia (AVRT) using right sided accessory pathway as requisite lime were documented in all patients.The conduction interval over these accessory pathways was relatively longer than that of usual accessory pathways,and the ablation catheters were placed at the annulus rather than the displaced AV groove.All AVRT were cured by radiofrequency catheter ablation. Conclusion:For a safe and successful ablation of accessory pathway,close attention must be paid to patients with Ebsteins anomaly.

关 键 词：EBSTEIN畸形 室上性心动过速 射频导管消融 

分 类 号：R542.530.5[医药卫生—心血管疾病] R541.710.5[医药卫生—内科学]