永存左上腔合并阵发性室上性心动过速的电生理特征和射频消融治疗

摘要

Objective To investigate the electrophysiological characteristics of paroxysmal supraventricular tachycardia(PSVT)associated with persistent left superior vena cava(PLSVC)and the safety and efficacy of their radiofrequency catheter ablation(RFCA). Methods Twelve consecutive patients with PLSVC out of 883 cases with PSVT who underwent RFCA at our hospital between July 2014 and Jan 2017 were included.Electrophysiological tests were performed and characteristics of radiofrequency ablation were analyzed. Results In 12 patients with PLSVC,88.9 percent were women(9 cases),with an average age of 35.1±11.8(23-57)years.Of those 9 patients were identified to be atrioventricular nodal reentrant tachycardia(AVNRT)by electrophysiological examination and ablation was successfully completed at the routine target site in only 2 patients,while the other 7 required ablation at the anterior wall of the coronary sinus ostium,where effective target potential was a relatively fractionated and complex atrial electrogram followed by a large ventricular electrogram(A/V ratio>1∶3).A type Wolff-Parkinson-White syndrome(A-WPW)was confirmed in the other 3 patients.Transseptal approach was used successfully for ablation in 3 patients with A-WPW. Conclusions RFCA of PSVT associated with PLSVC is feasible and safe.For AVNRTs,the majority of target sites were located in the anterior wall of the coronary sinus ostium.The ablation strategy of A-WPW associated with PLSVC was not different from conventional method.%目的 回顾性分析阵发性室上性心动过速合并永存左上腔患者的解剖和电生理特征,明确射频消融治疗的安全性和有效性.方法 连续入选2014年7月至2017年1月于首都医科大学附属北京安贞医院行射频消融治疗室上性心动过速的患者883例,其中12例(1.4%)患者合并永存左上腔.收集临床资料,行射频消融治疗,分析其电生理特征和治疗特点.结果 12例合并永存左上腔的室上性心动过速患者年龄23~47岁,平均(35.1±11.8)岁,女性9例.其中9例为房室结折返性心动过速(AVNRT),均为慢快型,其他3例为A型预激综合征.9例AVNRT中仅2例在常规慢径区域消融成功,其他7例均在冠状窦前缘距窦口1 cm内消融始能成功,这7例成功消融靶点局部电位小A,大V(A波高频,复杂,AV比例>1∶3).3例A型预激综合征均经穿间隔途径消融成功.结论 室上性心动过速合并永存左上腔多数为AVNRT,大部分成功靶点位于冠状窦前缘距窦口1 cm内.A型预激综合征合并永存左上腔消融与未合并永存左上腔相似.