左中间隔房室旁道的射频消融

Radiofrequecy catheter ablation on left midseptal accessory pathyways.

对 12例左中间隔房室旁道的心内电生理特点及其导管射频消融的方法学进行了分析。男 5例、女 7例 ,心动过速史 5～ 2 0年 ,年龄 46± 2 1岁 ,显性旁道 5例、隐匿性旁道 7例。显性旁道的体表心电图有Ⅰ、Ⅱ两种类型。结果 :显性旁道中心电图呈Ⅰ型者 3例、呈Ⅱ型者 2例。患者均成功地进行了射频消融 ,靶点位于左中间隔 ,其中 1例为慢旁道。操作时间 90± 30min、X线曝光时间 30± 11min、放电 13± 5次。 1例患者在消融时将His束和旁道同时阻断 ,导致Ⅲ度房室阻滞 ,另 1例为完全性左束支阻滞。结果提示左中间隔旁道较罕见 ,对左、右后间隔附近的旁道反复标测未找到理想靶点时 ,应考虑左中间隔旁道的可能 ;

To analysis electrocardiophysiologic feature and catheter ablation of 12 patients with left midseptal accessory pathways (APs).Included 5 male cases and 7 female cases,history of tachycardia ranged from 5 to 20 years,mainfest APs and concealed APs were 5 cases and 7 cases respectively.mainfest APs were classifed into type Ⅰ and type Ⅱ according to their surface electrocardiogram.Result:Mainfest APs were type Ⅰ in 3 cases and type Ⅱ in 2 cases.Radiofrequency ablation were successfully in all cases and ablation sites were located in left midseptal area.Average procedure was 90±30 min and X ray time was 30±11 min.His bundle and APs were blocked simultaneusly lead to Ⅲ degree atrioventriculor block in 1 case,and 1 case was left bundle branch block.Conclusion:Occurrence of left midseptal APs was rare.If successful site was not found at right or left posterioseptal area,we should map left midseptal area.Procedure in ablation of left midseptal APs should avoid to injury His bundle.