左室起搏对判断左侧旁道射频消融终点的意义

Evaluation of Radiofrequency Catheter Ablation Endpoint in Patients With Left Accessory Pathway by Pacing in Left Ventricle

探讨左室起搏对判断左侧旁道射频消融终点的价值。 6 4例左侧旁道患者进行了常规电生理检查和射频消融。按消融终点不同分二组 :A组消融后显性预激以delta波消失、右室心尖部 (RVA)起搏无旁道逆传 ;隐匿性旁道以RVA起搏旁道无逆传作为成功标准。B组除了A组标准外 ,再加上左室消融电极 (ABL)直接起搏 ,如旁道也无逆传 ,则终止消融。所有患者术后随访 1个月～ 1年。结果A组 5 0例 :显性预激 17例、隐匿性旁道 33例。显性预激即刻成功消融 16例 ,因反复发作心房扑动、心房颤动而未消融 1例 ;隐匿性旁道即刻成功 31例 ,因未诱发出心动过速及导管无法到位而未消融各 1例 ,术后 1～ 35天复发 5例 ,再次消融成功。B组 14例 :9例显性预激、5例隐匿性旁道。 9例显性预激消融后ABL起搏发现 4例残存隐匿性旁道 ,巩固消融后消失。 1例隐匿性旁道RVA起搏偶尔经左侧旁道逆传 ,而ABL起搏则旁道显示逆传 ,消融成功。B组术后无复发。结果提示 :左室起搏可揭示右心室起搏不显示的左侧隐匿性旁道。

To evaluate radiofrequency catheter ablation (RFCA) endpoint in patients with left accessory pathways by pacing in left ventricle (LV).From July 1993 to March 1999,Electrophysiologic testing and RFCA in 64 patients with left accessory pathway (AP) had been performed routinely.These patients were divided into two groups according to different RFCA endpoint.The criteria of group A was:Delta waves of manifest preexcitation were disappeared and retrograde conduction of AP was not found when pacing in right ventricle apex (RVA).The endpoint of group B:In addition to group A criteria,retrograde conduction of AP was not also found when paced with ablation catheter in LV.The patients were followed up for 1 month to 1 year.Results: Fifty patients in group A consisted of 17 manifest preexcitation and 33 concealed AP.Delta wave in 1 patient reappeared 3 hours after ablation,and RFCA was failed in 1 patient with manifest preexcitation.Supraventricular tachycardia (SVT) in 5 patients recurred within 1～35 days after ablation and was eliminated secondly by RFCA,the procedure of RFCA failed in 2 patients with concealed AP.14 patients in group B consisted of 9 manifest preexcitation,5 concealed AP.4 of 9 patients with manifest preexcitation after ablation were found leaving retrograde conduction of AP when paced by ablation catheter in LV,and the retrograde conduction lost after energy was given secondly.1 patient with left concealed AP was found that the retrograde conduction of AP was showed clearly when paced by ablation catheter in LV,but only appeared occasionally when paced in RVA.It was abolished by application of radiofrequency current.There was not recurrency in group B.Conclusion: Left concealed AP not to be found by RVA pace can be detected when pacing in LV by ablation catheter.LV pace plays an important effect on evaluating whether left AP is thoroughly interrupted or not,and on reducing recurrence of SVT after RFCA.[Chinese Journal of Cardiac Pacing and Electrophysiology,2000,14(2):93～95] Accessory pathway,left Catheter ablation,radiofrequency current Atrioventricular accessory pathway,concealed Pacing in left ventricle