射频消融位于冠状静脉窦憩室处的后间隔房室旁路.docVIP

射频消融位于冠状静脉窦憩室处的后间隔房室旁路 作者：牟瑞起　马坚　李克清　郑昭芬　李传昶　王方正 单位：253014 山东省德州市人民医院(牟瑞起　李克清);中国医学科学院　中国协和医科大学　心血管病研究所　阜外心血管病医院(马坚　王方正)；湖南医科大学湘雅医院(郑昭芬　李传昶) 　　关键词： 射频消融；冠状静脉窦憩室；旁路 　　【摘要】　目的　报道5例冠状静脉窦憩室处后间隔房室旁路的射频消融结果。　方法　对5例后间隔显性房室旁路患者进行电生理检查和射频消融术。术后冠状动脉造影,以观察冠状静脉窦形态。　结果　所有患者的冠状静脉窦近端有一憩室,并在憩室的颈部消融阻断房室旁路。成功靶点图:心室激动较体表心电图Δ波提前(31±3.7)ms,其中4例患者伴有旁路电位。　结论　冠状静脉窦憩室与后间隔旁路存在着解剖关系。术中冠状静脉窦造影检查有助于发现憩室和确定有效的消融部位。 　　adiofrequency catheter ablation of a posteroseptal accessory pathway within a coronary sinus diverticulum　MU Ruiqi,MA Jian,LI Keqing,et al.People′s Hospital of Dezhou City,Dezhou 253014 　　【Abstract】　Objective　To report the result of radiofrequency catheter ablation for five patients with posteroseptal accessory pathway within coronary sinus diverticulum.　Methods　Electrophysiologic study and radiofrequency catheter ablation were performed in five patients with overt posteroseptal accessory pathway.The morphologic features of the coronary sinus was also studied with coronary angiography.　Results　A diverticulum attaching the proximal coronary sinus was found and the associated accessory pathway was successfully ablated at the neck of diverticulum in all of these five patients.Local ventricular activation at the successful sites was (31±3.7) ms earlier than the delta wave,and in four patients an accessory pathway potential was recorded.　Conclusions　　Coronary sinus diverticulum is anatomically intimately related to the posteroseptal accessory pathway.Coronary venography during the ablation session is very helpful to detect the diverticulum and identify the effective ablation site. 　　【Key words】　Radiofrequency ablation　　Coronary sinus diverticulum　　Accessory pathway 　　冠状静脉窦憩室是一种少见的先天性心脏静脉系统畸形,常合并有位于心外膜侧的后间隔房室旁路［1～4］。本文报道5例此类患者的房室旁路射频消融结果,并结合文献报道,就其冠状静脉窦憩室的解剖结构特点和相关房室旁路的射频消融方法作一初步探讨。 　　资料和方法 　　1.病例 　　5例患者,男性1例,女性4例,平均年龄36.6±11.2岁。阵发性室上性心动过速病史7～11年。体表心电图表现为预激综合征,查体、超声心动图和X线胸片未发现异常。既往史中,3例患者曾接受过1次射频消融治疗,但未成功。 　　2.心内电生理检查和消融方法 　　经静脉途径放置电极导管于高位右房(HRA)、冠状静脉窦(CS)、希氏束(HBE)记录部位和右室心尖部(RV)。进行心房和/或心室