合并永存左上腔的房室结折返性心动过速射频消融的特点

Nine patients of AV nodal reentrant tachycardia associated with persistent left superior vena cava

目的:回顾总结合并永存左上腔房室结折返性心动过速(AVNRT)患者的电生理特点以及射频消融的安全性和有效性。方法:连续入选2012年6月至2015年8月,本中心采用射频消融治疗的典型AVNRT患者375例,其中有9例(2.4%)患者合并有永存左上腔,分析其射频消融成功靶点的特点。结果:9例合并有永存左上腔的患者中,女性8例(88.9%),平均年龄(62.3±7.2)岁,平均发病年龄(35.6±5.8)岁。其中仅2例在常规的慢径靶点位置消融成功,其余7例需要在冠状窦前缘距离窦口1cm以内位置才能消融成功。成功消融靶点为相对复杂的心房电位和大的心室电位(心房电位/心室电位振幅比值>1∶3),和常规靶点位置相比阻抗升高大约20Ω。结论:对于合并永存左上腔的AVNRT患者,射频消融是安全和可行的,大部分成功消融靶点位于冠状窦前缘距离窦口1cm以内的非常规位置。

Objective： To investigate the electrophysiological characteristics of atrioventricular nodal reentrant tachycardias（ AVNRTs） associated with PLSVC and the safety and efficacy of their radiofrequency catheter ablation（ RFCA）. Methods： Nine consecutive patients with PLSVC out of 375 with AVNRT who underwent RFCA at our center between June 2012 and Aug 2015 were included. Electrophysiological tests were performed and characteristics of radiofrequency ablation were analyzed. Results： In the nine patients with PLSVC,88. 9 percent were women（ 8 cases）,with an average age of（ 62. 3 ± 7. 2） years. The average age of onset was（ 35. 6 ± 5. 8） years old. Ablation was successfully completed at the routine target site in 2 patients,while the other 7 required ablation at the anterior wall of the coronary sinus within 1 cm from the ostium,where effective target potential was a relatively fractionated atrial electrogram followed by a large ventricular electrogram（ A / V ratio〉 1∶ 3） and impedance was approximately 20Ω higher than at the routine target site. Conclusion： RFCA is feasible and safe for AVNRTs associated with PLSVC,with the majority of target sites located in the anterior wall of the coronary sinus within 1 cm from the ostium.