与冠状静脉窦肌袖相关的左侧心外膜旁道的射频消融

Catheter ablation of epicardial accessory pathway associated with coronary sinus musculature

目的报道与冠状静脉窦肌袖相关的左侧心外膜旁道的射频消融经验及旁道定位、电生理特征。方法回顾性分析2009年1月至2011年7月共721例左侧旁道消融资料，17例[男性11例，平均年龄（37±17）岁]至冠状静脉窦内消融（2．4％），而如果除外其中6例外院失败病例，则发生率仅为1．5％。结果17例左侧心外膜旁道中，11例位于心中静脉，余6例位于二尖瓣环侧后壁。少数心中静脉旁道可存在憩室。所有病例均消融成功，放电开始至旁道阻断时间平均为1．1～10．0（4．7±2．7）S。多数病例在靶点可记录到较明显的旁道电位（10例）。平均随访（21±16）个月，有1例心中静脉内旁道在3个月时复发，再次人院行消融成功，其余患者无复发。所有患者均无并发症发生。结论约1．5％～2．4％的左侧旁道可与冠状静脉窦肌袖相连接需要至冠状窦内消融，其中多数位于心中静脉，少数位于冠状静脉窦后侧壁。体表心电图Ⅱ导联负向“△”波对心中静脉旁道预测率为100％。经冠状静脉窦心外膜消融安全可行．远期成功率较高。

Objective To report the single-center clinical experience of catheter ablation of epicardial accessory pathway associated with coronary sinus musculature. Methods The data of 721 cases of left sided accessory pathway ablation were retrospectively analyzed. Ablation in the coronary sinus was performed in 17 （2. 4 % ） cases [ 11 males, mean age （37 -＋ 11 ） years ]. Results Among the 17 cases, the accessory pathway was successfully ablated in middle cardiac vein and posterior lateral coronary sinus in 11 and 6 cases, respectively. Devertieulum of middle cardiac vein was seen in 2 cases. Mean time required to block the accessory pathway was （4. 7 _＋ 2.7 ） s. An accessory pathway potential could be recorded at the target site in 10 out of 17 patients （59%）. During a mean （21 -＋ 16） months follow up, only one patient experienced recurrence who was successfully cured by a second ablation session. No procedure related complication was reported. Conclusion About 2. 4% of left accessory pathway may have epieardial connection locating at middle cardiac vein or lateral part of the coronary sinus and require epieardial ablation. The epicardial ablation is safe and effective, warrants an excellent long-term results.