摘要
目的:总结多旁道及旁道伴双径的电生理特点及射频消融方法。方法:多旁道11例,其中体表心电图呈显性预激3例,正常8例;治疗采用先消融显性旁道,后消融阻断所有旁道顺序。旁道伴双径21例,电生理检查中观察PSVT发作时前传及逆传途经,然后对AP或SP进行消融治疗。结果:多旁道11例,共22条AP,成功率100%。旁道伴双径21例,其中慢径前传-旁道逆传10例,快径前传-旁道逆传4例,慢径-旁道折返伴快径-旁道折返2例,慢-快径交替前传折返2例,慢径前传-快径逆传(旁道旁观)3例。21例患者均作AP消融,诱发AVNRT者作SP消融。术后随访半年均无复发及并发症。结论:多旁道及旁道合并双径多需经腔内电生理检查才能被确诊,体表心电图可提供某些诊断线索。逐条消融是可避免多旁道的漏诊漏治;AP合并双径者,无论旁道是否作为旁观者,治疗关键是阻断旁道,旁道消融后应常规再次做房室结电生理检查,如仅有AH跳跃,不必接受房室结改良。
Objective：To discuss the characteristics of electrophysiology and the method of ablation of multiple atrioventricular accessory pathways（MAP） and atrioventricular accessory pathways（AP） with dual atrioventricular nodal pathways（DAVNP）.Methods：Among the 1 lpatients with MAP, the ECG showed 3 with manifest accessory pathways and 8 with conceal ones.The manifest accessory pathways were ablated firstly, and then the conceal ones.Of the 21 patients with AP and DAVNP, the antegrade and retrograde conduction pathways were examined,and the AP or slow pathway（SP） was ablated if necessary,Results：Among the 11 patients with MAP,22 pathways were successfully ablated one by one.Of the 21 patients with APand DAVNP, the reentrant pattern with antegrade conduction by SP and retrograde conduction by AP was induced in 10 patients,antegrade conduction by FP and retrograde conduction by AP was induced in 4 patients,4 pafienfs manifested, antegrade conduction by SP or FP simultaneously or alternatively, and 3 had SP and FP reentry.（AP as a bystander） Radiofrequency ablation of AP was performed on all patients and ablation of SP was performed on patients with the initiation of atrioventricular nodal teen,ant taehycardia （AVNRT）.No recurrence and complications occurred during follow-up.Conclusion： Most of MAP or AP with DAVNP could be found through eleetrophysiologic study （EPS）,the ECG could also give us some hints before the procedure.MAP should be ablated one by one in order to avoid missed diagnosis and treatment .As for the patients of AP with DAVNP, whether or not AP is a bystander, it is crucial to break the conduction of AP.EPS should be performed on AVN after AP was ablated.It seems unnessary to modify the AVN in patients only with the discontinuity of the AH interval.
出处
《中国医药导刊》
2010年第10期1691-1692,共2页
Chinese Journal of Medicinal Guide
关键词
多旁道
房室结双径
心动过速
室上性
射频消融术
Multiple atrioventricular accesary pathways
Dual attioventricular nodal Oathway
Tachycardia
Catheter study
