合并永存左上腔静脉的室上性心动过速导管消融结果分析

Cather ablation of supraventricular tachycardia in patients with persistent left superior vena cava

目的探讨合并永存左上腔静脉(PLSVC)的室上性心动过速(SVT)电生理检查结果和导管消融效果.方法回顾2011年11月至2019年10月在复旦大学附属中山医院接受导管消融治疗术的SVT患者,分析合并PLSVC者的电生理检查和消融结果.结果共入选SVT患者2260例,17例合并PLSVC.男7例,女10例,年龄(53.6±14.2)岁.房室结折返性心动过速(AVNRT)13例,房室折返性心动过速(AVRT)4例,其中3例左侧旁道中有2例为双旁道.SVT合并PLSVC的患者,AVNRT的比例以及左侧双旁道的比例均高于不伴PLSVC者,分别为(76.5%vs 51.4%,P<0.05)、(11.7%vs 1.2%,P<0.05).53.8%的AVNRT患者慢径消融靶点位于CS口内0.5~1 cm靠近前缘.左侧旁道者有1例需在CS内的心外膜面进行消融,且因复发接受了再次消融.随访(51.7±27.9)个月,17例经过18次消融过程,无复发和并发症.结论合并PLSVC的SVT以AVNRT为多见,消融靶点大多位于CS口内前缘;左侧旁道患者发生双旁道的概率较高,部分患者需要经CS内消融才能成功.

Objective To investigate the electrophysiological results and effects of catheter ablation in patients of supraventricular tachycardia(SVT)with persistent left superior vena cava(PLSVC).Methods Patients with SVT who underwent catheter ablation in Zhongshan Hospital,Fudan University from November 2011 to October 2019 were reviewed.The results of electrophysiological examination and ablation were analyzed in cases who were with PLSVC.Results There were 7 males and 10 females with an average age of(53.6±14.2)years.Atrioventricular nodal reentrant tachycardia(AVNRT)and atrioventricular reentrant tachycardia(AVRT)were 13 cases and 4 cases respectively.Two cases had left-sided double accessory pathways.In SVT patients with PLSVC,the proportion of AVNRT and left-sided double accessory pathways were higher than those without PLSVC(76.5%vs 51.4%,P<0.05),(11.7%vs 1.2%,P<0.05)respectively.The ablation target of slow pathway was 0.5-1 cm in CS near the anterior edge in 53.8%of patients with AVNRT.One patient with left-sided accessory pathway had to be ablated in CS through epicardial approach and had to be ablated again because of recurrence.The mean follow-up time was(51.7±27.9)months.There were no recurrence and complications in 17 patients after 18 procedures of ablation.Conclusion AVNRT is the most common type in SVT patients with PLSVC,and the ablation target was mostly located at the anterior edge of CS ostium.Patients with left-sided accessory pathways have a higher probability of double accessory pathways and some patients need to be ablated in CS to achieve success.