隐匿性右侧游离壁房室旁道定位及射频消融治疗

Localization and radiofrequency ablation treatment of concealed atrioventricular accessory pathways in right free wall

目的分析隐匿性右侧游离壁房室旁道房室折返心动过速(AVRT)心电图及心内电生理检查结果快速定位旁道,指导射频消融(RFCA)。方法 53例患者常规放置心内标测电极进行心内电生理检查,分析患者房室折返心动过速时体表心电图逆行P’极性不同及测量心动过速发作时His电极和CSO电极A波起点间期(ΔA)快速确定旁道部位,RFCA阻断旁道。结果 27例患者Ⅱ、Ⅲ、avF导联逆行P’波可分辨出其极性,初步确定旁道部位。前右侧壁(RAL)旁道13例ΔA(24.6±7.2)ms,右侧壁(RL)旁道16例ΔA(0.9±7.1)ms,右后侧壁(RPL)旁道24例ΔA(-27.2±11.4)ms。所有53例患者均经RFCA消融成功。结论 AVRT逆行P’极性不同及His电极和CSO电极A波起点间期测量可快速确定隐匿性右侧游离壁旁道部位,指导射频消融。

Objective To analyze the electrocardiogram of atrioventricular reentrant tachycardia（AVRT） and results of intracardiac electrophysiologic examination for rapidly localizing the concealed atrioventricular accessory pathways in the right free wall and guiding the radiofrequency ablation（RFCA）.Methods Intracardiac electrophysiologic examination was performed in 53 patients by routinely placing intracardiac mapping electrodes.Accessory pathways were rapidly localized by analyzing the polarity of retrograding P wave in surface electrocardiogram and measuring the period of A wave onset between His electrode and coronary sinus ostium electrode（ΔA） at AVRT,and RFCA was applied to block the accessory pathways.Results Accessory pathways were preliminarily localized in 27 cases by discernment of retrograding P wave polarity at Ⅱ,Ⅲ and avF leads.ΔA of the right anterior lateral（RAL） accessory pathways was（24.6±7.2）ms,ΔA of the right lateral（RL） accessory pathways was（0.9±7.1）ms,and ΔA of the right posterior lateral（RPL） accessory pathways was（-27.2±11.4） ms.All patients were successfully treated by RFCA.Conclusion Concealed atrioventricular accessory pathways in the right free wall could be rapidly localized by polarity of retrogradation P wave and measuring period of A wave onset between His electrode and coronary sinus ostium electrode（ΔA） at AVRT,which can guide RFCA.