导管射频消融右侧房室旁道的回顾性分析

Retrospective Analysis of Radiofrequency Catheter Ablation Used in Patients With Arrhythmiogenic Right Atrioventricular Accessory Pathway

对连续接受导管射频消融的５４例右侧旁道病人进行回顾分析，试图总结实用有效的常规消融方法。５４例中右游离壁旁道２８例、右前间隔９例、右中间隔５例、右后间隔１２例。１００％消融成功，无并发症。随访７．５±３．８个月，术后２４ｈ复发３例，３个月复发１例，均再次消融成功。右游离壁和右前间隔旁道较右中间隔和右后间隔旁道心室波提前程度大（２６．６±１４．２和２１．４±１０．７ｍｓｖｓ１６．３±１８．５和１４．５±１１．８ｍｓ，Ｐ＜０．０５），消融能量高（４３．３±５．４和３７．８±９．２Ｗｖｓ２１．４±７．１和２６．７±５．７Ｗ，Ｐ＜０．０５），Ａ、Ｖ波比值较小。中间隔和后间隔旁道较游离壁和前间隔旁道心房波振幅高（１．０±０．３和０．９±０．６ｍＶｖｓ０．５±０．４和０．６±０．３ｍＶ，Ｐ＜０．０５），导管较稳定。旁道在１ｓ内阻断者心室波提前程度、心房波振幅、导管稳定性和消融能量与旁道在５ｓ以上阻断者比较，差异有显著性（Ｐ＜０．０５），而且旁道阻断时间越短者，其心室波提前程度越大、心房波振幅越高，Ａ、Ｖ波比值越大，导管越稳定。提示影响右侧显性房室旁道消融成功率的主要因素是导管操作者的经验和对靶点图的识别，这些涉及到对消?

Fiftyfour patients (pts) with arrhythmiogenic right accessory pathway (AP) treated by radiofrequency catheter ablation were analyzed retrospectively in order to explore a practical and effective ablation procedure.45 pts (male 33 and female 21) were 3724 years old.APs were distributed in right free wall 28,anterior septum 9,middle septum 5 and posterior septum 12.All APs were successfully ablated without complications.In the followup of 7.53.8 months,there were 3 and 1 case of recurrence in 24 hours and 3 months after ablation.In free wall and anterior septum APs,there were earlier ventricular wave(26.614.2 and 21.410.7 ms vs 16.318.5 and 14.511.8 ms,P<0.05),higher ablation energy (43.35.4 and 37.89.2 W vs 21.47.1 and 26.75.7 W,P<0.05) and smaller atrioventricular wave (AV) ratio than in middle and posterior septum APs, but higher atrial wave amplitude (1.00.3 and 0.90.6 mV vs 0.50.4 and 0.60.3 mV,P<0.05),and more stable catheter position in middle and posterior septum APs.In the APs blocked within l s,there were earlier V wave (P<0.05),higher A wave amplitude (P<0.05),more stable catheter position and lower ablation energy (P<0.05).The quicker the AP ablated,the earlier the V wave,the higher A wave amplitude,the larger AV ratio and more stable catheter position.It is concluded that the main factors determining the success rate of AP ablation are operatorexperience and the recognition of the target electrogram.The effective steps to control these factors are combination of rough and precious AP mapping,correct energy delivery time judgement,immediate ablation effect evaluation and diagnostic ablation for rare complex pts.