第86课 基于左心房下外侧慢径路的慢快型房室结折返型心动过速:重整反应在选择消融靶点中的作用

Lesson Eighty-six Slow/fast atrioventricular nodal reentrant tachycardia using the inferolateral left atrial slow pathway-role of the resetting response to select the ablation target

房室结折返型心动过速(AVNRT)中的近90%为慢快型,其顺向慢径主要由房室结向右下延伸形成,位于Koch三角下方,消融此处发生房室传导阻滞的风险低。少数患者的慢快型AVNRT折返环前传支由房室结向左下延伸形成,距冠状窦口1～3cm的冠状窦顶部或二尖瓣环下间隔旁可成为靶点。极少数情况下,参与AVNRT的慢径与邻近二尖瓣环的左心房下外侧(IL-LA)基部相连接。我们称之为IL-LA慢径。

In the majority of cases of slow/fast Atrioventricularnodal reentrant tachycardia（AVNRT） , which occurs in≈90% of the patients, the anterograde slow pathway isformed by the rightward inferior extension of theatrioventricular node, which can be targeted for ablationwith a low risk of atrioventricular block at the inferiortriangle of Koch. In a smaller number of patients, theanterograde limb of the slow/fast AVNRT circuit isformed by the leftward inferior extension of theatrioventricular node, which can be targeted at the roofof the coronary sinus, ≈1 to 3cm from the coronarysinus ostium or from the inferior paraseptal mitralannulus.