间隔旁路定位及射频消蚀的体会

The experience in localization and ablation of septal accessory pathways

利用射频消蚀间隔旁路５６例。前间隔显性旁路肢导心电图δ波及主波均为正向（ａＶＲ除外），旁路距希氏束１ｃｍ左右，心内标测需准确判断希氏束位置。后间隔显性心电图Ⅰ、ａＶＬ的δ及主波正向，Ⅱ、Ⅲ、ａＶＦ负向；左后间隔Ｖ１的Ｒ／Ｓ≥１，Ｖ２呈大Ｒ波，右后间隔Ｖ１的Ｒ／Ｓ≤１。左后间隔旁路心动过速时ＶＡ为８０～１２０ｍｓ，置冠状窦导管近极于窦口，可在中极标测到ＥＡＡ，逆Ａ中极较近、远极早１０～３０ｍｓ。右后间隔旁路高右房部逆Ａ与希氏束比较提前不明显，冠状窦导管近极较中、远极早２０～３０ｍｓ，定位需粗标整个三尖瓣环，细标冠状窦口周１～２ｃｍ处瓣环。仔细分析旁路逆传激动顺序可以精确定位，成功消蚀。

Abstract The septal accessory pathways(AP) were ablated through catheter using radiofrequency current in 56 cases.In anteroseptal APs, both the delta wave and QRS were positive in the limb leads(except the Lead aVR), and the APs were to be about 1 cm from the His bundle. The position of which should be determined carefully in order to get an accurate mapping. In posteroseptal APs, the ECG showed positive delta and QRS wave in leads of I and aVL and negative in leads of II, III and aVF respectively. In left posteroseptal APs, the ratio of R to S in lead V2 was≥1. In right posteroseptal APs cases, the ratio of R to S was ≤1 both in V1and V2. The VA in the HBE during tachycardia with the left posteroseptal APs was 80-120 ms. Retrograde A wave of the middle electrode was earlier 10-30 ms than distal or proximal when the proximal electrode of the catheter was put at the ostium of cornonary sinus (CSo). In right posteroseptal, the retrograde A wave in the high right atrium electrolde was not apparently earlier than His bundle, but the time at proximal electrode in CS catheter was 20-30 ms earlier than middle and distal electrodes.To localize the right posteroseptal APs had to map the whole tricuspid annulum briefly and the vicinity around the CSo carefully. Analysis of the retrograde sequence of AP activation may localize and ablate the APs successfully.