宽房室旁道的心内电生理特点和消融特点  

Electrophysiological characteristics and radiofrenquency catheter ablation techniques of wide accessory atrioventricular pathway

作　　者：李飞鸥[1] 张建军[1] 陈明[1] 杨新春[1] 

机构地区：[1]首都医科大学附属北京朝阳医院心脏中心,北京100043

出　　处：《临床心血管病杂志》2016年第6期544-547,共4页Journal of Clinical Cardiology

摘　　要：目的：探讨宽房室旁道的心内电生理特点、消融的技巧。方法：总结分析10例宽房室旁道的临床资料、心内电生理特点及消融结果。结果：10例宽房室旁道：显性旁道（4例）,隐性旁道（6例）,消融靶点5-14（8.5±3.0）个,消融范围10.0-25.0（16.7±5.1）mm。1例患者术后1个月时心动过速发作,经心内电生理检查靶点位置仍位于原靶点范围内,通过再次射频消融成功;9例患者射频消融成功,随访无复发。1例患者术前心脏彩超检查存在主动脉瓣少量反流,术后1年随访无加重;余9例患者术前瓣膜功能正常,术后1年心脏彩超检查无瓣膜狭窄或关闭不全情况。10例患者消融术后均无瓣膜损伤。结论：宽房室旁道,在较大范围内均可标测到多处理想靶点,呈连续性,旁道长度可以超过10mm。欲成功消融宽房室旁道,需要在靶点图好的部位做到消融时间足（1-2min）、缓慢移动,使旁道被线性横断、避免漏点。术后需要注意增加观察时间。心内途径射频消融治疗宽房室旁道,安全性好。Objective：This paper aimed to investigate the electrophysiological characteristics and radiofrenquency catheter ablation techniques of wide accessory atrioventricular pathway.Method：We reviewed the clinical data,electrophysiological characteristics and results of radiofrenquency catheter ablation in 10 patients with accessory atrioventricular pathway.Result：There were 10 patients of wide accessory atrioventricular pathway,4manifest accessory pathways and 6concealed accessory pathways.A median of 8.5±3.0（5-14）radiofrenquency applications were needed to eliminate wide accessory atrioventricular pathway in 10 patients.The distance of the accessory atrioventricular pathway was about 16.7±5.1（10.0-25.0）mm.One patient was relapse after radiofrequency catheter ablation in 1month.We found the target in primary location and successful ablation after mapping again.Nine patients were all succeed,no relapse.One patient has aortic small valvular regurgitation before ablation and no deteriorate with 1-year follow-up.Nine patients had normal valve function before ablation.With 1-year follow-up,no valvular stenosis or valve regurgitation were detected after ablation.Ten patients had no valve injury after ablation.Conclusion：Wide accessory atrioventricular pathway had multiple radiofrequency applications in broad and linear range.They were 10 mm or more long.Mapping carefully,moving catheter slowly,enough time of ablation in every ideal target site（1-2min）with enough energy,ablating continuously and avoiding leakage may help increase the success rate.After radiofrequency ablation,we need prolong the observation time to ensure the conduction of atrioventricular pathway abolished.It was safe and effective for radiofrequency catheter ablation via the endocardial access to block wide accessory atrioventricular pathway.

关 键 词：宽房室旁道 电生理 射频消融 

分 类 号：R541.7[医药卫生—心血管疾病]