右前间隔房室旁路的自右房侧射频消融术

RADIOFREQUENCY CATHETER ABLATION OF RIGHT ANTEROSEPTAL ATRIOVENTRICULAR ACCESSORY PATHWAY FROM RIGHT ATRIUM

右前间隔房室旁路是整个导管消融中较为困难的部位。我们以射频电流消融4例均获成功。消融部位为希氏束导管正上方。3例患者记录到旁路电位。旁路与希氏束的平均距离为4.9 mm。当大头导管记录到大A小V波且无或仅有微小希氏束波时放电。1例并发不完全性右束支阻滞。平均随访8个月无复发。

Right anteroseptal atrioventricular accessory pathway is the most difficult one for radiofrequency catheter ablation due to its nearby normal conduction system. Four patients with symptomatic tachyarrhythmias mediated by right anteroseptal pathways were ablated successfully. The large-tip ablation catheter was positioned just above the His bundle catheter. Accessory pathway potential was recorded in 3 patients. The mean distance between pathway and His bundle was 4.9 ram. Radiofrequency current was delivered when a large atrial and a small ventricular potentials were recorded by ablation catheter, with no or tiny His bundle potential. 1 patient was complicated by incomplete right bundle branch block, There was no recurrence after a mean follow-up of 8 months, Conclusion: Radiofrequency current ablation of right anteroseptal accessory pathway is an effective and safe modality.