显性旁道射频导管消融术中顺传与逆传分离现象及原因分析

Unidirectional Block of Overt Accessory Pathway during Radiofrequency Catheter Ablation

目的探讨显性旁道射频导管消融（下称消融）中顺传与逆传分离现象及其原因。方法对14例预激综合征患者行常规心内电生理检查及消融。结果右侧旁道12例，左侧旁道2例，初次有效靶点消融时均出现旁道顺传与逆传分离现象。2例左侧旁道证实为斜行旁道，后在逆传A波最早点继续消融成功，4例患者置入Swartz鞘管后在原理想靶点继续放电后成功消融，6例患者同样在原理想靶点基础上靠近心房侧或心室侧消融成功，2例患者为右侧双旁道，按常规方法标测消融另一隐匿性旁道。结论显性旁道消融中出现顺传与逆传分离现象，可能机制为旁道损伤、斜行旁道、宽旁道或多旁道。

Objective To explore the mechanisms of unidirectional block of overt accessory pathway （AP） during radiofrequency catheter ablation （RFCA）. Methods 14 patients with Wolff-Parkinson-White syndrome underwent electrophysiologic test and RFCA. Results Left AP was determined in two cases and right AP in 12 cases. All patients showed only anterograde or retrograde block of AP after first ablation at the effective target site, An oblique course was identified in 2 left AP and ablated successfully at the site of the earliest retrograde atrial activation. Ablation was successfully performed using a Swartz sheath in 4 cases and by moving ablation electrode to artrial or ventricular side from optimal target site in another 6 cases. Additional AP was identified and ablated in 2 cases with right AP. Conclusion Injured AP, an oblique course of AP, a broad AP and multiple AP may be the causes of unidirectional block of AP during RFCA.