穿间隔法与经主动脉逆行法消融左侧房室旁道的对比研究

A Randomized Comparison Between Retrograde and Transseptal Approach for Radiofrequency Ablation of Left Sided Accessory Pathways

按随机化原则对１２７例左侧房室旁道分别采用穿间隔（ＴＳ）法（６６例）和经主动脉逆行（ＴＡ）法（６１例）进行射频消融。ＴＳ法成功率１００％，ＴＡ法为９５％（５８／６１），两者相比无显著性差异。３例ＴＡ法失败者同次采用ＴＳ法消融成功。ＴＳ法和ＴＡ法消融操作时间依次为７６±２３和８１±２１ｍｉｎ、Ｘ线照射时间为１２±８和１３±７ｍｉｎ、放电次数为３±２和３±３次，各参数分别进行比较，均无显著性差异。随访９．１±４．９月，ＴＡ法消融有１例心动过速复发，经ＴＳ法再次消融成功。两组病人均无并发症发生。

One hundred and twenty seven patients (Pts) were randomly assigned to undergo retrograde transaortic approach (TA) in 61 cases and transseptal approach(TS) in the other 66 patients for ablation of left sided accessory pathways(APs).By TA,the large tip electrode was positioned under the mitral annulus,whereas it was on the atrial aspect along mitral annulus by TS.One hundred and twenty four Pts were successfully treated by ablation through TS or TA.Three Pts with unsuccessful initial TA were successful ablated with TS.There were no difference in total procedure time (76±23 min vs 81±19 min),fluoroscopy time (12±8 min vs 13±7 min) and total energy applications (3±2 times vs 3±3 times) between TS and TA group.There was no complication in the two groups.In TA group,one recurred in 2 months and was successfully reablated by TS.These results indicated that either TS or TA has a highly successful rate for ablation of left sided APs.Whichever method could be taken as ones pleases.TS is a complement to TA.