房室多旁道的电生理特征及其射频消融治疗

Study of electrophysiological characteristics and radiofrequency ablation for multiple accessory pathways

目的 探讨房室多旁道的电生理特点及射频消融方法。方法 2 3例患者经电生理检查确定房室多旁道 ,应用心房和心室刺激诱发室上速 ,确定每条旁道的电生理特征及与心动过速的关系 ,按照标测部位对相关旁道逐步消融 ,以射频消融成功确定旁道位置。结果 2 3例中检出旁道 49条 ,其中三条旁道 3例 ;左侧多旁道 12例 ,右侧多旁道 2例 ,双侧多旁道 9例 ;左侧多旁道以隐匿性为主 ;右侧多旁道多为显性 ;未见心动过速时右侧旁道前传而同侧旁道逆传现象。结论 多旁道患者应首先确定和消融与心动过速相关旁道 ;左侧多旁道应以诱发心动过速或快速心室起搏方法标测 ;右侧多旁道应同步描记 12导联体表心电图 ,旁道消融成功可能仅见于QRS波的变化 ;双侧多旁道应首先消融左侧旁道。

Objective to investigate the electrophysiological characteristics and method of catheter ablation for multiple accessory pathways (MAP).Methods 23 patients with MAP were identified by electrophysiological examination. They were induced supraventricular tachycardia with atrial and ventricular stimulation to confirm the electropgysi- ological characteristics of every pathway related to tachycardia.The AP were ablated step by step. The location of AP were identified by successful ablation.Results 49 Aps were found in 23 cases including left APs in 12 cases, right APs in 2 cases and left as well as right Aps in 9 cases. Left APs is almost conceal conduction. Right Aps is almost dominance conduction but don't found retrograde conduction using another right Aps in tachycardia attack.Conclusions MAP should be ablated for AP related to tachycardia first.Left APS should be mapped under inducing tachycardia or rapid pacing ventricle. The 12 leads of surface ECG should be recorded in ablation of right MAP because changes of QRS wave can be indicated successful ablation one AP of MAP. Left AP should be ablated fist in left and right Aps.