摘要
目的总结心房插入点远离三尖瓣环的右侧游离壁旁道的体表心电图及腔内电生理特点,以及消融经验。方法从2006年1月到2009年5月,共对127例右侧旁道患者进行了射频消融,入选其中有过失败消融经历的21例患者。术中在右室心尖部起搏标测逆向心房最早激动点。心房插入点的定义是最早逆行心房激动点,并且消融这一点可成功阻断旁道。随访6个月以上并定期进行12导联心电图检查。结果 21例中12例(8例显性旁道,4例隐匿性旁道)旁道的心房插入点远离三尖瓣环。心电图显示V1预激程度小或呈QS样。电生理检查和消融发现其中4例的心房插入点在右心耳基底部,5例在右房高侧壁,3例在右房低侧壁。在心房插入点处消融可成功阻断旁道。心房插入点距三尖瓣环距离20.5±2.9 mm。随访6个月以上,所有患者旁道传导未恢复,未出现心动过速发作。结论右侧旁道的插入点可能远离瓣环,正确认识体表心电图及腔内电生理特征有助于提高消融成功率。
Objective It is difficult to ablate a right-sided accessory pathway （AP） with atrial insertion far from the tricuspid annulus （TA）. We report the electrophy-siologic characteristics and our initial experience of ablating this type of rare AP. Methods From January of 2006 to May of 2009, 21 patients with right-sided APs who failed previous ablations were enrolled in this study. Retrograde AP conduction was mapped during pacing at the right ventricular apex. AP atrial insertion was defined as the earliest retrograde atrial activations and successful ablation of the APs at this site. Results Among the 21 patients who had failed previous ablation, 12 patients （8 patients with right manifest APs and 4 patients with right conceal APs） had atrial insertions far from the TA. Of the 12 patients, the atrial insertions were found at the base of the RA appendage in 4 patients, high lateral RA in 5 patients,low lateral RA in other 3 patients. Ablation at the atrial insertions successfully abolished the AP conduction. The mean distance between the atrial insertion sites and the TA was 19. 8 ± 2.9mm, No patients reported recovered AP conduction or recurrent tachy-eardias after 6-month follow-up. Conclu- sions The right-sided APs may have atrial insertion far from the TA. Electrocardiogram and intracardiae electrophysiologic characteristics are of great importance in identification and ablation of these APs.
出处
《中国心脏起搏与心电生理杂志》
北大核心
2011年第4期319-322,共4页
Chinese Journal of Cardiac Pacing and Electrophysiology
关键词
电生理学
右侧旁道
远离三尖瓣环的心房插入点
心电图
Electrophysiology
Right-sided accessory pathway
Atrial insertion far from the tricuspid annulus
Electrocardiogram
