心外膜旁路的识别和射频消融治疗

Recognition and catheter ablation of epicardial accessory pathways

目的 报道左侧心外膜旁路的特点和经冠状静脉窦射频消融术的结果。 方法 5例左侧旁路患者先经心内膜标测和消融 ,由于不成功改由经冠状静脉窦标测 (左心室心外膜标测 ) ,记录到旁路电位即进行消融。 结果 5例患者全部成功 ,成功消融靶点 :左侧游离壁 2例 ,左后间隔冠状静脉窦憩室 3例。有效靶点均标测到振幅较大的旁路电位 ,其振幅大于 A波和 V波。 结论 冠状静脉内标测到振幅较大的旁路电位是左侧心外膜旁路的重要标志 ;

Objective To characterize left side accessory pathways that traverse the atrioventricular groove epicardially and to treat these accessory pathways with radiofrequency ablation within the coronary sinus. Methods The study group comprised of 5 patients with left side accesory pathways.At first,the ablation catheter was introduced into femoral artery and positioned on the ventricular aspect of mitral annulus.The RFCA by this endocardial approach was unsuccssful,the ablation catheter was introduced into the coronary sinus and energy applied there. Result All five patients ultimately were successfully ablated using radiofrequency energy within the coronary sinus.Effective target sites were characterized by an large accessory pathway potential on electrograms in the coronary sinus. Conclusions The absense of an accessory pathway potential during endocardial mapping in combination with an relatively large accessory pathway potential within the coronary sinus may be a useful marker of a epicardial pathway.Epicardial accessory pathway conduction can be successfully interrupted by radiofrequency ablation within coronaroy sinus.