射频消融治疗Mahaim纤维介导心动过速疗效分析

Radiofrequency ablation of reentry tachycardia mediated by Mahaim fiber

关键词:  Mahaim纤维  心动过速  导管消融

Key words:  Mahaim fiber  tachycardia  catheter ablation

摘要:

[摘要]　目的　评价Mahaim纤维介导心动过速的电生理特点和射频消融治疗的有效性和安全性。　方法　回顾性分析中国医科大学附属盛京医院心内科2005年3月至2014年1月诊断的34例Mahaim纤维患者的电生理特点。采用在三尖瓣环上标测Mahaim纤维电位或标测最早心室激动波，或者在机械操作损伤旁路传导部位进行靶点的标测，进而消融治疗Mahaim纤维旁路。　结果　所有病例均消融成功。25例标测到Mahaim纤维电位。6例在三尖瓣环附近最早心室激动点进行消融。3例在标测过程中出现一过性旁路传导功能中断处消融。30例靶点分布于三尖瓣环8～10点范围内，4例位于右前侧壁和右后间隔。　结论　根据Mahaim纤维的电生理特点，选择相应的标测方法，可以提高消融治疗成功率。

Abstract:

[Abstract] Objective To evaluate the efficacy and safety of radiofrequency ablation on reentry tachycardia mediated by Mahaim fiber. Methods 34 patients, who were diagnosed as antidromic atrioventricular reciprocating tachycardia attributed to atriofascicular pathways, underwent electrophysiological exam and ablation in Shengjing Hospital at China Medical University since March 2005. The Mahaim fiber potential or earliest ventricular activation recorded around the tricuspid valve was considered as ideal ablation target. If the accessory pathway conduction was interrupted by the mechanical bump, ablation was applied at the bump site. Results All the patients were successfully ablated. Mahaim fiber potential was identified in 25 patients. Ablation was applied at earliest ventricular activation site in 6 patients, and in 3 patients at bump site where leaded to transient accessory pathway conduction interruption. The target sites were located at right lateral wall around tricuspid valve in 30 patients, the other 4 target sites at right anterior lateral wall or right posterior septal wall. Conclusion Reentry tachycardia mediated by Mahaim fiber can be successfully ablated according to its electrophysiological properties.