前传递减性旁路的标测和消融

The mapping of radiofrequency ablation of Mahaim's fiber

目的 总结Mahaim’s纤维参与折返的心动过速的电生理特点和射频消融结果。方法 对 7例患者 ,其中男 5例 ,女性 2例 ,平均年龄 2 6 7岁± 7岁 (18～ 35岁 )的左束支传导阻滞型心动过速患者进行了射频消融。在心动过速、窦性心律或心房起搏情况下 ,消融导管沿三尖瓣环心房面标测 ,标测到有明显Mahaim’s束电位处作为消融靶点。结果 7例患者全部消融成功 ,旁路只有递减性前向传导功能 ,7例患者均属于Mahaim’s纤维分型中的房束纤维。靶点位置全部在三尖瓣环的心房侧 ,均能标测到明显的Mahaim’s束电位。术后平均随访 (2 1± 8)个月 ,1例复发后再次消融成功。结论 本文 7例患者均属于Mahaim’s纤维分型中的房束纤维 ,成功消融靶点均能记录到明显的Mahaim’s束电位。我们的体会是消融此类纤维最好能记录到Mahaim’s束电位 ,消融心房的插入点 ,此方法成功率高。

Objectives To evaluate the electrophysiologic features and the effect of radiofrequency ablation of Mahaim's fiber. Methods Seven patients [2 women and 5 men, mean age (26 7±7) years] of the tachycardia with a left bundle branch block pattern underwent electrophysiologic evaluation and radiofrequency ablation. Accessory pathway potential might record at the successful ablation site along the tricuspid annulus mapping during tachycardia or sinus rhythm or atrial stimulation. Results All accessory pathways in the five patients were found to conduct only the anterograde direction with decremental conduction properties. The fibers of All patients are belong to atriofasci cular fibers, and all accessory pathways were successfully ablated at the tricuspid annulus with recorded the accessory pathway potential. The tachycardia recur in one patient during a mean follow up of (21±8) months. Once ablation was successful. Conclusions The fibers of All patients are belong to atriofascicular fibers, and all accessory pathways were successfully ablated at the tricuspid annulus with recorded the accessory pathway potential. We realize where can the accessory pathway potential be recorded at the successful ablation site. The ablation method has more higher successful and more few complication as well as the fluoroscopy time was shortened significantly.