中间隔右侧旁道的特殊类型──邻希氏束旁道的定位和消融治疗

The Localization and Ablation of Special Pattern of Right Midseptal Accessory Pathway──Parahisian Accessory Pathway

报道６例中间隔右侧旁道的特殊类型──邻希氏束旁道的射频消融治疗，心内标测和消融证实该类旁道位于中间隔右侧的前上部，邻近希氏束的影象显示其距离在０．５ｃｍ以内，有效消融靶点局部电图均记录到Ｈ波（≤０．０１ｍＶ），其振幅明显小于希氏束电图Ｈ波振幅，Ｖ─Ａ间期短于或等于希氏束电图上的Ｖ─Ａ间期，Ｖ波与Ａ波之间有旁道电位，强调在房室折返性心动过速时放电，６例患者心动过速在放电５ｓ内终止，其中４例出现交界区早搏或短阵交界心律，２例出现窦性心动过速，停止放电后均恢复窦性心律。笔者提出恢复后的窦性心律无房室传导阻滞是旁道阻断而正常房室传导无损伤的重要依据。连续放电可完全阻断旁道。

It was reported that six patients were treated with radiofrequency current ablation (RFCA)of their accessory pathway (AP) which localized in the right midseptal areas of the heart and very closed to the His bundle, The location of these APs was called ' parahisian' in this study, It was verified by intracardiac mapping and RFcA that these pathways were located in the superior space of the right midseptal area of the heart. The distance between ablative target and His bundle electrode was within 0. 5 cm measured by right oblique projction 30 degree. The bipolar electrogram in successful sies always showed very small H wave(≤0. 01 mV),which was much smaller than that of His bundle electrogram (HBE),the short VA interval, which was equal to or less than that of HBE,and a AP potential. The radiofrequency current was delivered during atrioventricular reentrant tachycardia. The successful ablation always showed that the tachycardia was terminated within 5 seconds, there was no evidence of normal AV conduction damage in the following sinus rhythm, and continous delivery of radiofrequency current could completely abolish AP conduction.