左室起搏标测消融左侧隐匿性旁道靶点的探讨

The Study of Mapping the Concealed Left-sided Accessory Pathways With Pacing Left Ventricular

探讨左侧旁道 (AP)构成的房室折返性心动过速 (AVRT)的标测及射频消融 (RFCA)靶点定位方法。 15 4例左侧隐匿性AP构成的AVRT随机分成A、B两组 ,两组均经股动脉逆行法进入大头电极 (ABL)于二尖瓣环下RFCA。A组经大头电极以S1S135 0～ 5 0 0ms沿二尖瓣环起搏 ;以起搏信号S到CS上最早逆传A波之间的间距S -A最小处为靶点。B组以AVRT和 /或右室心尖部起搏时CS最早逆传A波处为靶点。结果 :A组 75例均经 1～ 2次放电即成功阻断AP ,且V、A分离均在放电后 5s内出现。其中有 9例靶点与CS上最早逆行A波处相距 10～ 15mm ,其靶点处S-A较其余 6 6例明显延长。B组 79例中 6 8例在 1～ 2次放电 ,5s内V、A分离 ,另 11例放电无效在改用A组方法后均在一次放电后即阻断AP ,靶点距CS最早逆A波处 10～ 2 0mm ,S -A显著长于该组其他病例。 15 4例中 2 0例靶点与CS上最早逆行A波有距离 ,其S -A明显延长 (5 6± 2 3msvs 4 5± 12ms,P <0 .0 1)。结论 :以最短S -A为靶点能快速有效地阻断各种类型的左侧隐匿性AP ;尤其在以最早逆行A波为靶点无法阻断AP传导时推荐使用该方法。

To find a way of mapping the localization of the ventricular insertion site of concealed left-sided accessory pathways(AP), 154 patients with concealed left-sided AP were divided into group A(75 patients) and group B(79 patients) at random.Ventricular pacing was delivered along the mitral annulus at a cycle length of 350 to 500 ms in group A and measured the conduction interval from the pacing stimulus to the earliest retrograde atrial electrogram recorded in the coronary sinus (S-A),the site with the shortest S-A were the target site.in group B, radiofrequency energy was delivered to the site with the earliest retrograde atrial activation in coronary sinus during atrioventricular reentant tachycardia or pacing via right ventricle apex .Results: In group A, AP were eliminated in all patients within twice and in 5 seconds. The earliest retrograde atrial activation site didn′t coincide with the shortest S-A site in 9 of 75 patients, and the shortest S-A in the 9 patients was longer than the rest (P<0.01). In group B,AP were eliminated in 68 of 79 patients within three times and in 5 seconds, The rest 11 ones were mapped and ablated in the way as same as group A,S-A in 11 patients was longer than the others(56±25 ms vs 45±13 ms,P<0.01). Conclusion: The site with the shortest S-A is a good way that can quickly and accurately eliminated all kinds of concealed left-sides AP.