Mahaim型旁路14例电生理特点及射频消融

Electrophysiological characteristics of Mahaim type accessory pathway and treatment with radiofrequency catheter ablation

目的探讨Mahaim旁路的电生理学特点、诊断、鉴别诊断和射频消融。方法根据详细的心内电生理检查和射频消融的结果,探讨14例与Mahaim旁路有关的心动过速的电生理学特点及分型。结果8例为慢传房束旁路,2例为结束旁路,4例为慢传导房室旁路。所有Mahaim型旁路均仅有单向前向、递减性传导,12例患者可在三尖瓣环记录到Mahaim旁路电位,其中慢传导房束/结束旁路者在心房S1S1、S1S2刺激、心动过速发作及心房拖带时,VH间期较慢传导房室旁路者为短(P<0.001)。所有病例的射频消融治疗均获成功。结论详细的电生理检查对Mahaim型旁路的诊断、电生理分型及成功的射频消融治疗十分重要。

Objective To evaluate the electrophysiological characteristics of Mahaim type accessory pathway, and the experiences of radiofrequency catheter ablation. Methods Fourteen patients suffered from symptomatic Mahaim type accessory pathway tachycardia were included in the study according to cardiac electrophysiology and the results of radiofrequency catheter ablation. ECG and cardiac programmed stimulation were performed to determine the category. Results Eight subjects suffered from superventricular tachycardia with the forward conduction of atrialfascular accessory pathway, 2 with nodefascular accessory pathway, and 4 with atrialventricular accessory pathway. In the subjects of atrialfascular/nodefascular accessory pathway , the V-H interval during HRA S1S1 and S1S2 stimulation, supreventricular tachycardia and atrial entrainment were significantly shorter than those of atrialventricular accessory pathway （ P 〈 0. 001 ）. All the subjects were successfully ablated when radiofrequency energy was released at the location where obviously AP potential was recorded. Conclusion Careful electrophysiological examination is necessary to determine the pattern of Mabaim fiber and differentiate them from other analogous tachycardia and proceed successful radiofrequency catheter ablation.