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目的探讨特殊左侧旁路射频导管消融中的策略。方法选取2013年全年行射频导管消融的左侧旁路患者288例,其中,11例在消融中有一定特殊性,包括6例存在裂隙现象,3例为左侧慢旁路,1例合并小儿麻痹,外周血管严重迂曲,1例为阵发性房颤、房扑合并房室显性旁路。经主动脉逆行途径在二尖瓣心室侧、穿间隔途径在二尖瓣心房侧及冠状静脉窦内行射频消融。结果 11例患者均消融成功。6例经主动脉逆行途径,在二尖瓣心室侧消融成功;4例经房间隔穿刺,在二尖瓣心房侧消融成功;1例经冠状静脉窦内消融成功。术后无并发症。6例在低频率(周长400 ms以上)刺激时无室房逆传,在高频率(低于350 ms周长)刺激时出现旁路逆传,室房逆传呈现裂隙现象。3例为左侧慢旁路,心室逆传时VA间期明显延长,靶点处VA不融合。1例为外周血管严重迂曲,经主动脉逆行途径无法到达靶点,后改为经房间隔穿刺途径消融成功。1例为阵发性房颤、房扑合并左前壁房室显性旁路,成功隔离肺静脉电位及阻滞三尖瓣环峡部线后,在距离冠状窦口约7 cm处,左心耳根部及冠状静脉窦内远端消融成功。结论左侧房室旁路导管射频消融存在特殊情况时,需仔细鉴别,通过不同的方法及途径消融,仍可获得较高的成功率。
Objective To explore the strategy of ablation of special left bypass radiofrequency catheter. Methods A total of 288 left bypass patients undergoing RF catheter ablation were selected in 2013. Among them, 11 patients had certain characteristics of ablation, including 6 cases of fissure, 3 cases of left bypass and 1 case of merger Polio, peripheral vascular serious tortuosity, 1 case of paroxysmal atrial fibrillation, atrial flutter combined with atrioventricular bypass. The aortic retrograde approach in the mitral valve ventricular side, through the mitral approach mitral atrial and coronary sinus internal radiofrequency ablation. Results All 11 patients had successful ablation. Six patients underwent retrograde aortic retrograde angioplasty successfully on the ventricular side of the mitral valve. Four patients underwent atrial septal ablation, which succeeded in atrial ablation of the mitral valve. One patient underwent successful ablation of the coronary sinus. No complications after surgery. There were no retrograde transfusions in 6 cases at low frequency (400 ms perimeter), and retrograde retrograde at high frequency (less than 350 ms perimeter). 3 cases of left bypass, ventricular reverse VA interval was significantly longer, the target VA is not fusion. One case of severe peripheral blood vessels tortuous pathways can not reach the target through the aortic retrograde, after the change to atrial septal puncture ablation success. 1 case of paroxysmal atrial fibrillation, atrial flutter and left anterior chamber atrioventricular bypass, the successful isolation of pulmonary venous potential and block the tricuspid valve ring line, at a distance of about 7 cm from the coronary sinus, left atrial appendage Department and coronary sinus distal ablation success. Conclusion There are special cases of left atrioventricular catheter radiofrequency catheter ablation, which need to be carefully identified. Through different methods and methods of ablation, a higher success rate can still be obtained.