楚建民 马坚 王方正 张奎俊 陈新 孙瑞龙 中国医学科学院心血管病研究所 中国协和医科大学阜外心血管病医院 临床电生理研究室 北京 100037 中国心脏起搏与心电生理杂志 2000 0 14 3


    关键词：冠状静脉窦；心外膜旁道；导管消融，射频电流 期刊 zgxzqbyxdslzz 0 180-182 临床研究 fur -->


    

摘要 报道13例左侧心外膜旁道的特点和经冠状静脉窦射频消融的结果。13例左侧旁道患者先经心内膜标测和消融，如不成功改由经冠状静脉窦标测，记录到旁道电位或最早激动的V波或逆传A波即进行消融。结果：13例患者全部成功，平均放电1.5±0.6次，能量21±4 W，时间21±9 s。成功消融靶点：左侧游离壁2例、左后间隔冠状静脉窦憩室4例、心中静脉7例。11例有效靶点均标测到振幅较大的旁路电位，其振幅大于A波和V波，与二者之比均大于1。结论：冠状静脉窦标测到振幅较大的旁道电位是左侧心外膜旁道的重要标志；冠状静脉窦消融可以有效地阻断心外膜侧旁道。

    中图分类号 R541.7⁺ 7 文献标识码 A

    文章编号 1007—2659(2000)03—0180—03

Radiofrequency Catheter Ablation of Subepicardial Accessory Pathways Via the Coronary Sinus.

CHU Jian-min, MA Jian,WANG Fang-zheng,et al.

To describe the technique for catheter ablation of left accessory pathways by radiofrequency energy applied at the epicardium through the coronary sinus.Methods:The study group comprised 11 posteroseptal or posterolateral and 2 left free wall accessory pathways patients.Initially,the endocardial mapping was used,if this endocardial approach was unsuccessful,the ablation catheter was introduced into the coronary sinus and energy applied at sites with recording accessory pathway potential.Result:All 13 patients had successful ablation with in the coronary sinus with a mean radiofrequency pules of 1.5±0.6 and a mean duration of 21±9 s at a mean power of 21 ±4 W.The effective target sites:7 within middle vein,4 at the neck of coronary sinus diverticulum and 2 at left free wall.11 patients effective target site electrograms in coronary sinus were characterized by accessory pathway potential that was larger than the corresponding atrial and ventricular electrogram.Conclusion:The absence of an accessory pathway potential during endocardial mapping in combination with a relatively large accessory pathway potential within the coronary sinus may be a useful marker of a epicardial pathways.Radiofrequency catheter ablation via the coronary sinus appears to enhance efficacy.

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