摘要
目的 总结前传递减性右心房 -右心室旁路的电生理特点和射频消融结果。 方法 对 7例患者 ,其中男性 3例 ,女性 4例 ,平均年龄 (32± 16 )岁左束支阻滞图形的逆向型房室折返性心动过速患者进行电生理检查和射频消融治疗。 结果 7例患者的旁路只有递减性前向传导功能 ,三磷酸腺苷能够阻断旁路的传导。心动过速时 ,行心房期前刺激和标测心室最早激动点 ,证实旁路起止于邻近三尖瓣环的右心房和右心室。于三尖瓣环上成功消融所有的旁路 ,消融部位的局部 V波明显提前 [平均 V-δ间期(2 5± 4) ms],但不伴有旁路电位。平均随访 (16± 5 )个月 ,无 1例心动过速复发。 结论 前传递减性右心房 -右心室旁路是“Mahaim样纤维”的一种类型 ,射频消融术为有效的治疗方法 ,成功消融部位可不伴有旁路电位。
Objective To evaluate the electrophysiologic features and the effect of radiofrequency ablation of right sided atrioventricular accessory pathway with anterograde decremental conduction. Methods Seven patients [4 women and 3 men,mean age (32±16) years] with antidromic atrioventricular reentrant tachycardia having a left bundle branch block pattern underwent electrophysiologic evaluation and radiofrequency catheter ablation. Results All accessory pathways in these seven patients were found to conduct only in the anterograde direction with decremental conduction properties.Programmed atrial stimulation and adenosine triphosphate (ATP) each caused accessory pathway conduction delay and Wenckebach block.The results of right atrial extrastimulation and mapping earliest ventricular activation during antidromic atrioventricular reentrant tachycardia,suggested that both atrial and ventricular insertions of these accessory pathways were immediately contiguous to the tricuspid annulus.All accessory pathways were successfully ablated at the tricuspid annulus with the earliest ventricular activation [mean V δ interval:(25±4) ms],but no accessory pathway potential was recorded.Tachycardia did not recur during a mean follow up of (16±5) months. Conclusions The right sided atrioventricular accessory pathway with anterograde decremental conduction is one type of Mahaim like fiber.Radiofrequency current applied to the tricuspid annulus can safely eliminate accessory pathway conduction.Accessory pathway potential may not be recorded at the successful ablation site.
出处
《中华心律失常学杂志》
2000年第2期103-107,共5页
Chinese Journal of Cardiac Arrhythmias
