His束记录部位非常靠近冠状窦口的房室结折返性心动过速的消融治疗

Radiofrequency Ablation of Atrioventricular Nodal Reentrant Tachycardia When His Bundle Potential Site Is Extremely Near Coronary Sinus Orifice.

探讨His束记录部位非常靠近冠状窦口时的房室结折返性心动过速 (AVNRT)的射频消融方法及有效性。对7例His束记录部位非常靠近冠状窦口的AVNRT的患者进行射频消融 ,男 5例、女 2例 ,年龄 6 5 .3± 3.5 (6 0～ 75 )岁。常规放置电极导管至高位右房、His束和冠状窦 ,发现 4例记录到最大His束电位的部位与冠状窦口位于同一水平线 ,3例在其下方 2～ 4mm。采用左前斜位 (LAO) 4 5°和右前斜位 30°,尤其是LAO 4 5°在最大His束电位记录部位下方 ,细标靶点 ,当A波碎裂 ,或记录到慢径电位 ,而无His束电位时试放电消融。 6例成功 ,其中 4例在LAO相当于 6点处消融成功 ,2例在 6点半左右处成功 ,1例应用了Swartz鞘。平均手术时间 1.5± 0 .3h。随访 1～ 2年 ,6例成功患者未见复发。结论 :对His束最大记录部位非常靠近冠状窦口的患者 ,主要在LAO 4 5°冠状窦口下方细标靶点 。

In order to explore the method and feasibility of radiofrequency ablation of paroxysmal atrioventricular nodal reentrant tachycardia(AVNRT) When His bundle potential site is extremely near coronary sinus orifice.Seven patients(male 5,female 2,mean age 65.3±3.5 years) whose maximal His bundle recording sites were extremely near the orifice of coronary sinus with AVNRT were given radiofrequency ablation.The electrode catheters were inserted into high right atrium,His bundle and coronary sinus routinely.The maximal His bundle recording sites of 4 patients were found to parallel the orifice of coronary sinus horizontally,while those of 3 patients just under the latter about 2～4 mm.The ablation targets were carefully mapped under the maximal His bundle potential recording sites mainly through left anterior oblique 45 ° (LAO 45 °) view in combination with right anterior oblique 30 ° view.When the focal potential presented fragmentation of A wave or slow pathway potential without His bundle potential,radiofrequency energy was delivered.The results showed that 6 patients succeeded while 1 patient failed.Four patients succeeded at 6 o′clock under LAO 45 ° while 2 patients at half past six.The mean ablation time was 1.5±0.3 hours.One patient was performed using Swartz sheath.Six patients with success had no recurrence of tachycardia during the follow up period of 1 to 2 years.Conclusion:The target sites should be mapped under the orifice of coronary sinus mainly through LAO 45 ° and this will help increase success rate of slow pathway ablation and save time in the patients with the maximal His bundle potential recording sites extremely near the orifice of coronary sinus.