González-Torrecilla Esteban, Arenal Angel, Atienza Felipe, Almendral Jesús
Arrhythmia Unit, Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Am J Cardiol. 2005 Aug 15;96(4):564-9. doi: 10.1016/j.amjcard.2005.04.020.
Three-dimensional electroanatomic mapping was performed to guide radiofrequency catheter ablation in 17 patients with accessory pathways (APs) who had undergone 2.0 +/- 0.9 previous unsuccessful conventional procedures. In 14 patients, activation mapping was directed at the atrial insertion of the bypass during tachycardia (6 patients) or right ventricular pacing (7 patients) or by mapping atrial stimulus-delta-wave intervals. The ventricular insertion of the bypass was mapped and targeted for ablation in the remaining 3 patients. Successful AP ablation was obtained in all but 1 patient (94%) after a mean of 8 +/- 7 radiofrequency pulses, without recurrences during a mean follow-up of 16 +/- 15 months. On the basis of mapping results and successful ablation outcomes, the most likely causes of previous failed ablation attempts were anatomic or mapping reasons (13 patients), catheter manipulation-related problems (2 patients), and miscellaneous reasons (1 patient).
对17例曾接受过2.0±0.9次既往常规手术但未成功的旁路传导通路（AP）患者进行三维电解剖标测以指导射频导管消融。在14例患者中，心动过速期间（6例患者）或右心室起搏时（7例患者）通过标测心房激动或通过标测心房刺激 - δ波间期来进行旁路心房插入部位的激动标测。对其余3例患者进行旁路心室插入部位的标测并将其作为消融靶点。除1例患者外（94%），平均8±7次射频脉冲后所有患者均成功消融旁路传导通路，平均随访16±15个月期间无复发。根据标测结果和成功消融结果，既往消融失败最可能的原因是解剖或标测原因（13例患者）、导管操作相关问题（2例患者）和其他原因（1例患者）。
