心外膜房室旁路的射频导管消融  

Radiofrequency catheter ablation of epicardial atrioventricular accessory pathway

作　　者：李茂楠[1] 王祖禄[2] 梁延春[2] 梁明[2] 韩雅玲[2] 

机构地区：[1]解放军第四军医大学研究生院,西安710032 [2]沈阳军区总医院心内科

出　　处：《中华心律失常学杂志》2011年第1期11-18,共8页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的探讨不同部位心外膜房室旁路（AP）的电生理特点及射频导管消融的方法学及结果。方法36例心外膜AP患者，男性17例，年龄9～74岁，均伴房室折返性心动过速，7例有1—3次导管消融失败病史，经心内膜途径标测无理想消融靶点和／或经导管消融失败后，分别经冠状静脉系统（尤心中静脉）、无冠窦、右心耳、右侧游离壁标测到理想AP电位或AV（VA）相对最近或融合处，应用普通射频导管或换用盐水灌注射频导管，分别于上述部位消融。结果36例中，在心脏静脉系统内消融成功28例，其中25例在心中静脉内或其口部附近消融成功；无冠窦内消融成功1例；右心耳内消融成功2例，其中1例复发后再次消融失败，最终经心外科手术成功；5例右侧游离壁心外膜AP，经沿三尖瓣环心房侧线性消融成功电隔离AP4例，失败1例。结论心外膜AP的发生率为1．9％，多数（78％）位于心脏静脉系统（尤心中静脉）内，部分位于右侧游离壁，心耳内或无冠窦内罕见。术前通过分析体表心电图预激波极性可预测多数伴显性预激的心脏静脉系统心外膜旁路，在经心内膜标测和／或导管消融AP过程中如有疑问时应注意排除心外膜AP。盐水灌注射频导管可能有助于提高心外膜AP的消融成功率。Objective To investigate the electrophysiological characteristics, the techniques and re- suits of radiofrequency catheter ablation in patients with epicardial atrioventricular accessory pathway （AP）. Methods Thirty-six patients （17 male ） with epicardial AP and atrioventricular reentrant tachycardia （AVRT） underwent electrophysiological study and catheter ablation were studied. Seven patients had failed catheter ablation for 1 to 3 times. After initial endocardial mapping did not achieve optimized target site or abla- tion failed to eliminate AP conduction, the ablation catheter was introduced into the coronary sinus （ especially the middle cardiac vein）, the noncoronary cusp, the right or left appendage, and/or the right atrial free wall around the tricuspid annulus to map the AP potential or the relatively earlier A-V or V-A site. Radiofrequency ablation was delivered at these sites using the common 4-mm tip catheter or shifting to saline-irrigated tip cathe- ter if the common catheter failed to eliminate the AP. Results Twenty-eight of the 36 patients （78%） had successful ablation in the coronary vein system,including 25 patients having AP ablated in the middle cardiac vein or its near site. AP was eliminated inside the noncoronary cusp in 1 patient. In 2 patients who had a suc- cessful AP ablation inside the right appendage. One of them had AVRT recurrence and failed re-ablation and was eventually cured by cardiac surgery. Among the 5 patients with the right-sided lateral free wall AP, linear ablation along the atrial side of the tricuspid annulus isolated the AP from atrium in 4 patients, and the other 1 patient had a failed ablation. Conclusion The incidence of epicardial AP is 1.9% o Most of them （78%） were located in the coronary vein system （especially in the middle cardiac vein or its near site）, some in the right-sided free wall, and rare in the right appendage. The epicardial AP should be considered if endocardial mapping did not show ideal target site or radiofrequency cu

关 键 词：房室折返性心动过速 房室旁路 心外膜 冠状静脉窦 导管消融 

分 类 号：R541.7[医药卫生—心血管疾病]