显性旁道在心房颤动时的标测与消融

Mapping and ablation of manifest accessory pathway during atrial fibrillation

目的 探讨心房颤动 (Af)时对显性旁道 (AP)的标测与消融方法。方法 7例 AP患者 ,年龄 2 4～ 6 0岁。均有阵发性 Af史。Af发作伴旁道前传时的心室率为 12 0～ 2 0 0 bpm。采用经主动脉逆行法消融左侧旁道 ,经股静脉途径消融右侧旁道 ,以心室前向激动点最早、且有小 A波为靶点。结果 7例患者标测到了较体表心电图预激波起点提前 2 5～ 5 0 ms的 V波 ,首次消融以 15 W能量放电 ,均在 1s～ 8s内旁道前传阻断。3例在旁道前传阻断的同时转为窦性心律 ;1例 30 min内自行转为窦性心律 ;3例经药物转为窦性心律。行心室起搏 ,6例旁道逆传已阻断 ,1例经消融后逆传阻断。随访 5～ 45个月 ,无旁道前传恢复的证据 ,亦无室上性心动过速发作。结论 在掌握适应证的前提下 ,Af时行射频消融阻断显性旁道是可行的。

Objective To evaluate the way of mapping and ablation of manifest accessory pathway(AP)during atrial fibrillation(Af).Methods 7 consecutive patients(24~60years)including 5 left-sided Aps and 2 right-sided Aps,who had ongoing atrial fibrillation with anterograde conduction over accessory pathway,were ablated by radiofrequency current.Of them,7 patients had a history of paroxymal atrial fibrillation.Left Aps were targeted via retrograde aortic approach and right-sided Aps via femoral vein.The successful ablated target site included earliest ventricular activation in relation to the onset of preexcitation in the surface electrocardiogram and small atrial potential.Results At the successful ablation sites,local ventricular activation during atrial fibrillation showed 25~50ms before the onset of preexcitation in the surface electrocardiogram?Anterograde AP conduction was successfully ablated with only once radiofrequency application whose output is 15W during Af in 7 patients.At the same time sinus rhythm were restored spontaneously in 3 patients,30 minutes later in one patient and after medicine cardioversion in 3 patients.Retrograde block of the Aps was confirmed by ventricular pacing in all but one patient,in which a successful secondary ablation was achieved.During follow-up of 5~45 months,none had evidence of anterograde Ap conduction.and recurrence of superaventricular tachycardia.Conclusion Radiofrequency catheter ablation of manifest accessory pathway during Af is feasible under suitable condition.