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目的总结心房插入点远离三尖瓣环的右侧游离壁旁道的体表心电图及腔内电生理特点,以及消融经验。方法从2006年1月到2009年5月,共对127例右侧旁道患者进行了射频消融,入选其中有过失败消融经历的21例患者。术中在右室心尖部起搏标测逆向心房最早激动点。心房插入点的定义是最早逆行心房激动点,并且消融这一点可成功阻断旁道。随访6个月以上并定期进行12导联心电图检查。结果 21例中12例(8例显性旁道,4例隐匿性旁道)旁道的心房插入点远离三尖瓣环。心电图显示V1预激程度小或呈QS样。电生理检查和消融发现其中4例的心房插入点在右心耳基底部,5例在右房高侧壁,3例在右房低侧壁。在心房插入点处消融可成功阻断旁道。心房插入点距三尖瓣环距离20.5±2.9 mm。随访6个月以上,所有患者旁道传导未恢复,未出现心动过速发作。结论右侧旁道的插入点可能远离瓣环,正确认识体表心电图及腔内电生理特征有助于提高消融成功率。
Objective To summarize the body surface electrocardiogram (ECG) and intracavitary electrophysiological characteristics of the right atrial freefall in the atrial insertion site away from the tricuspid annulus, and the experience of ablation. Methods From January 2006 to May 2009, a total of 127 patients undergoing radiofrequency ablation of the right accessory pathway were enrolled in the study. Twenty-one of the 21 patients who had failed ablation procedures were enrolled. Intraoperative apical pacing in the right ventricle marked the earliest point of atrial activation. Atrial insertion point is defined as the earliest retrograde atrial activation point, and ablation of this can be successfully blocked bypass. Follow-up more than 6 months and regular 12-lead ECG. Results In 21 cases, 12 cases (8 cases of dominant and 4 cases of concealed bypass) atrial insertion point away from the tricuspid annulus. ECG showed a small pre-excitation V1 or QS-like. Electrophysiological examination and ablation found in 4 cases of atrial insertion at the base of the right atrial appendage, 5 cases in the right atrial high side wall, 3 cases in the right atrial low side wall. Ablation at the point of atrial insertion can successfully block the bypass. Atrial insertion distance from the tricuspid annulus 20.5 ± 2.9 mm. Follow-up more than 6 months, all patients did not resume the conduction pathway, no tachycardia attack occurred. Conclusion The insertion point of the right side of the bypass may be far from the annulus, correct understanding of the surface ECG and intracavitary electrophysiological features help to improve the success rate of ablation.