经冠状静脉窦射频消融心外膜旁道

Radiofrequency Catheter Ablation of Subepicardial Accessory Pathways Via the Coronary Sinus.

报道 13例左侧心外膜旁道的特点和经冠状静脉窦射频消融的结果。 13例左侧旁道患者先经心内膜标测和消融 ,如不成功改由经冠状静脉窦标测 ,记录到旁道电位或最早激动的V波或逆传A波即进行消融。结果 :13例患者全部成功 ,平均放电 1.5± 0 .6次 ,能量 2 1± 4W ,时间 2 1± 9s。成功消融靶点 :左侧游离壁 2例、左后间隔冠状静脉窦憩室 4例、心中静脉 7例。 11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 ,与二者之比均大于 1。结论 :冠状静脉窦标测到振幅较大的旁道电位是左侧心外膜旁道的重要标志 ;

To describe the technique for catheter ablation of left accessory pathways by radiofrequency energy applied at the epicardium through the coronary sinus.Methods:The study group comprised 11 posteroseptal or posterolateral and 2 left free wall accessory pathways patients.Initially,the endocardial mapping was used,if this endocardial approach was unsuccessful,the ablation catheter was introduced into the coronary sinus and energy applied at sites with recording accessory pathway potential.Result:All 13 patients had successful ablation with in the coronary sinus with a mean radiofrequency pules of 1.5±0.6 and a mean duration of 21±9 s at a mean power of 21 ±4 W.The effective target sites:7 within middle vein,4 at the neck of coronary sinus diverticulum and 2 at left free wall.11 patients effective target site electrograms in coronary sinus were characterized by accessory pathway potential that was larger than the corresponding atrial and ventricular electrogram.Conclusion:The absence of an accessory pathway potential during endocardial mapping in combination with a relatively large accessory pathway potential within the coronary sinus may be a useful marker of a epicardial pathways.Radiofrequency catheter ablation via the coronary sinus appears to enhance efficacy.[Chinese Journal of Cardiac Pacing and Electrophysiology,2000,14(2):180～182]