射频消融左侧旁道有效消融点标准探讨

ELECTROPHYSIOLOGICAL CRITERIA FOR IDENTIFICATION OF SUCCESSFUL ABLATION SITES FOR RADIOFREQUENCY CATHETER ABLATION OF LEFT FREE-WALL ACCESSORY PATHWAYS IN PATIENTS WITH WPW SYNDROME

报道３０例预激综合征左侧旁道射频消融（ＲＦＣＡ）有效和无效消融点放电前的电生理特点。结果表明：①显性旁道有效消融点特征为房室传导时间极短（≤３０ｍｓ），房波和室波间无等电位线，室波等于或超前标测电极室波；②隐匿旁道有效消融点特征为逆传房波紧随室波后，室波和房波间无等电位线，逆传房波等于或超前标测电极房波。认为ＲＦＣＡ中正确识别上述特征有助于提高消融疗效和减少放电次数。

The characteristics of electrograms recorded at successful (30) and unsuccessful (68) sites of radiofrequency catheter ablation (RFCA) were analyzed in 30 patients with left free-wall accessory pathways (AP).It was found that clear atrial waves were recorded at successful and unsuccessful sites during normal sinus rhythm and there was no difference in A/V (bipolar ablation electrogram;Ab12) and P/R (unipolar ablation electrogram;Ab1) at successful and unsuccessful sites. In 8 patients with manifest WPW syndrome the electrograms recorded at successful sites showed very short atrioventricular conduction time, and AV (Ab12) and PR (Ab1) interval were equal to or less then 30 ms; and there was no isoelectrical line between A and V wave in Ab12. The V wave at Ab12 (Vab)occurred simuti aneously or earlier than V wave at mapping (Vm). Antegrade AP potentials were recorded in 3 of 8 successful sites and none of 24 unsuccessful sites recorded AP potentials (p<0. 025). In 22 patients with concealed WPW syndrome the electrograms recorded at successful sites showed that retrograde atrial wave at Ab12 and Ab1 occurred simultaneously or earlier than atrial wave at mapping sites, there was no isoelectrical line between V and A wave at Ab12. Retrograde AP potentials were recorded in 8 of 22 successful sites and none of 52 unsucce ssful sites recorded AP potnetial (p<0. 001). It is concluded that successful site of RFCA has characteristics of electrogram at Ab12 and Ab1, with which one sould predict the success or failure of RFCA of accessory pathways and minimize the number of unnecessary application of radiofrequency energy.