右前游离壁房室旁路射频消融术中Swartz鞘、小弯标测消融电极导管的应用价值

The value of Swartz sheath and small-curve mapping and ablating catheter in radiofrenquency catheter ablation(RFCA)of right anterior atrioventricular accessory pathway

目的:评价Swartz鞘、小弯标测消融电极导管在右前游离壁房室旁路射频消融术中应用价值。方法:1998年5月至2004年12月共44例经心内电生理证实的右前房室旁路患者,其中男性26例,女性18例,年龄12￣57岁(平均20.1±6.8)。显性旁路34例,隐匿旁路10例,8例院外射频消融失败,4例6个月内复发。心动过速史1￣20年。抗心律失常药物难以有效预防发作。停用抗心律失常药物5个半衰期以上后,常规穿刺静脉和放置电极导管行心内电生理检查。在R0Swartz鞘管支持下,将小弯标测消融电极导管于右房上部塑型为倒“U”字形,使用旋转导管、适当增减导管弯度和推送导管三种力量,在三尖瓣环处移动标测确定消融靶点,以30￣50W的功率消融房室旁路。结果:44例患者有效消融靶点位于右前游离壁。所有患者消融均获成功。无并发症出现。平均手术时间61.3±22.6min,X光曝光时间22.4±8.6min。随访8个月～18个月,无一例复发。结论:右前游离壁房室旁路射频消融中Swartz鞘支持下应用小弯标测消融电极导管能提高消融成功率,有较高的应用价值。

Objective：To evaluate the value of Swartz sheath and small-curve mapping and ablating catheter in RFCA of right anterior free-wall atrioventricular accessory pathway.Methods：During May-1998 to Dec-2004, there were 44 RAP patients enrolled in the study （26 males,18 females,mean age 20.1±6.8 years ）.Among them, 34 patients were of manifest type,and 10 patients were concealed type;8 patients had unsuccessful RFCA in other hospitals;4 had recurrent tachycardia within 6 months.All patients endured a tachycardia history of 1 to 20 years,and antiarrhythmatic drugs had little or no effect.After stopped using those medicines till five half-life times,they recaiued electrophysiological examination under usual procedure：puncturing femoral venous electrode catheter placing,and modeling small curve mapping and veform the catheter into reversed- ＂U＂-type in the upper right atrial with the support of RO Swartz sheath,revolved catheter in clockwise direction,regalated the curvature tpush catheter.Mapping targets along tricuspid valve annulus accurately,then 0 ablating right atrioventricular pathway at 30-50W.Results：Effective ablation target locate the elcetored in right anterior free wall.RFCA in all 44 patients were performed successfully,with no complications occurring.It took 61.3±22.6min of ablation procedure time and 22.4±8.6min of X-ray exposure.In the period of 8-18 months follow-up,none of the patients reoccurred tachycardia.Conclusion：The support of Swartz sheath,using small- curve mapping and ablating catheter may enhance success rate in RFCA of right anterior free-wall atrioventricular accessory pathways,which possesses a better applicative value.