左侧房室旁道射频消融治疗中的导管定位问题

Catheter electrode localization during radiofrequency ablation of left-sided accessary AV pathways

采用三种方法在三个不同时期对15例左侧房室旁道进患者行导管射频消融治疗。这三种方法是;(1)在三维透视下对接导管电极的立体定位消融法;(2)左房室环直接标测定位消融法;(3)单导管标测消融法。尽管15例病人均消融成功,但后两种方法的总操作时间和x线曝光时间明显短于第一种方法(P<0.01)。因此,作者认为在左侧房室旁道的射频导管消融中,(1)以冠状窦导管精确标测后、或一律在旁道电位指引下以多平面透视良好对接冠状窦靶电极与大头消融电极进行消融的方法操作时间及x线曝光时间长、无效消融次数多且标测和消融不直观,不宜推广使用;(2)在冠状窦大致定位方向的指引下,以大头电极直接精确标测定位左房室环旁道并进行消融的方法操作简单、省时、直观、有效,可作为常规消融方法;(3)单导管标测和消融技术应限制在有丰富操作经验的导管班子中使用。

3 different catheter ablation methods have been used to ablate the leftsided accessary AV pathways by radiofreqency current. The methods were (1) making the ablation electrode in the ventriculum to point to the target electrode in the coronary sinus under fluroscopy planes of PA, LAO30 and RAO30, (2) mapping the mitral anulus directly with the ablation electrode under the rough guidance of the coronary target electrode and (3) the single catheter technique. Although all the 15 patients were all treated successfully without complication, yet the mean ablation number, time needed for the procedure and X-ray exposure were significantly different. It was concluded that (1) the method of directing the ablation electrode to the coronary target electrode under multiplane fluroscopy is unappropriate because of prolonged X-ray exposure and time consuming catheterization procedure, (2) the method of mapping the mitral anulus directly with the ablation electrode under the rough direction of coronary target electrode could be adopted as a regular technique for its simple catheteriztion procedure, less X-ray radiation and complete ablation effect and (3) the single catheter technique should only be adopted by experienced teams.