经冠状静脉窦标测和消融后间隔心外膜房室旁道

Radiofrequency Catheter Ablation of Epicardial Posteroseptal Accessory Pathways Through the Coronary Sinus.

报道心外膜房室旁道的特点和经冠状静脉窦射频消融术的结果。3例后间隔显性房室旁道患者先经心内膜标测和消融,不成功后改由经冠状静脉窦内标测和消融。术中冠状动脉造影,观察冠状静脉窦形态。结果: 2例冠状静脉窦近端有一憩室,并在憩室的颈部消融阻断房室旁道。成功靶点图为标测到振幅较大的旁道电位,其振幅大于A波和V波。结论:经心内膜标测和消融失败的旁道可能是心外膜旁道,行冠状静脉窦内标测与消融可有效阻断旁道,冠状静脉窦憩室与后间隔旁道可能存在着解剖关系。

To report the result of radiofrequency catheter ablation of epicardial accessory pathways through the coronary sinus. The endocardial mapping was used in 3 patients with overt posteroseptal accessory pathways. The ablation catheter was introduced into the coronary sinus and energy applied when the endocardial approach was unsuccessful. The morphologic features of the coronary sinus were also studied with coronary angiography. Result: A diverticulum attaching the proximal coronary sinus was found and the associated accessory pathway was successful ablated at the neck of diverticulum in 2 patients. The effective target site electrogram in coronary sinus was characterized by accessory pathway potential that was larger than the corresponding atrial and ventricular electrogram. Conclusions: It may be epicardial accessory pathways if the endocardial approach was unsuccessful. Epicardial accessory pathways conduction can be successful interrupted by radiofrequency ablation within coronary sinus. Coronary sinus diverticulum is anatomically related to the posteroseptal accessory pathways.