食管心电图辅助的心腔单导管消融房室旁路的方法学和临床意义

The method and clinical significance of ablation of atrioventricular accessory pathways via a single catheter approach with transesophageal electrocardiogram

目的 Kuck等提出的单导管消融房室旁路 (旁路 )的技术因缺乏心房电图而不适合隐匿旁路消融 ,也难以完整评价显性旁路消融的效果。本组报道经食管心电图 (TEE)辅助的心腔单导管法消融旁路的临床意义。 方法 2 8例患者中显性旁路 1 3例 (左侧 9例 ,右侧 4例 ) ,隐匿性旁路 1 5例 (左侧1 3例 ,右侧 2例 )。同步记录心电图、TEE和消融电极局部电图。显性旁路在窦性心律标测和消融 ,隐匿性旁路诱发顺向型房室折返性心动过速 (AVRT)时标测和消融。消融导管刺激心室观察 TEE房波评价消融疗效。 结果 2 8例均为单旁路参与的 AVRT,单导管消融成功 2 6例 (92 .9% )。左侧旁路消融的手术时间和 X线透视时间分别为 (2 5± 8) min和 (3 .9± 1 .3 ) min,右侧旁路消融则分别为 (3 4.2± 6.1 )min和 (1 0 .1± 5.1 ) min。 结论 TEE辅助的心腔内单导管消融法可有效阻断旁路和评价消融效果 ,是一种在熟练掌握常规消融技术的基础上可采用的消融方法。

Objective Kuck's single catheter approach technique has difficulties not only for ablating concealed accessory pathway (AP),but also for evaluating the results of ablation of manifest AP because of having no atrial electrograms as reference.This study describes a technique of ablating AP by a single catheter with adjunce transesophageal electrocardigram (TEE) and reports it's clinical usefulness. Methods 28 patients with manifest AP(9 on the left and 4 on the right) and concealed AP (13 on the left and 2 on the right) underwent this procedure.Surface ECG, TEE and local electrograms from the tip electrode of the ablation catheter were recorded.Manifest APs were mapped and ablated during sinus rhythm and concealed APs were mapped and ablated during orthodromic atrioventricular reentrant tachycardia (AVRT).The atrial electrogram on the TEE during stimulating ventricle with the ablation catheter was used for evaluating the efficacy of AP ablation. Results Each patient had only one AP which mediated AVRT.26 APs were blocked completely after delivering radiofrequency current with this technique(92 9%).The time of procedure and X ray exposure were 25±8 and 3 9±1 3 minutes in patents with left side AP,and 34 2±6 1 and 10 1±5 1 minutes in patients with right side AP. Conclusion The technique of single cathater ablation with the help of TEE is a useful method that can abolish AP conduction effectively.The experienced operators can use this method to treat some patients with manifest and concealed APs.