Turakhia Mintu P, Scheinman Melvin, Badhwar Nitish
Electrophysiology Section, Department of Medicine, Stanford University.
Indian Pacing Electrophysiol J. 2009;9(2):130-3. Epub 2009 Mar 15.
A 31-year old male presented with atrial fibrillation and ventricular preexcitation that was positive in leads V1-V4, negative in lead II, and positive in lead AVR. The patient was cardioverted and invasive electrophysiologic study was performed. Based on the ECG findings, the coronary sinus and its branches were interrogated during orthodromic atrioventricular reentrant tachycardia. The earliest local activation was seen in the true coronary sinus lumen at the bifurcation of the posterolateral branch. Radiofrequency energy application at this area led to loss of preexcitation. When localizing left septal and posterior accessory pathways, ventricular preexcitation that is both negative in II and positive in AVR has been shown in previous studies to be highly sensitive and specific for a subepicardial location. Therefore, investigation of the coronary sinus and its branches may allow for effective ablation without the need for left ventricular access.
一名31岁男性，表现为心房颤动和心室预激，V1 - V4导联呈阳性，II导联呈阴性，AVR导联呈阳性。患者接受了心脏复律，并进行了有创电生理研究。根据心电图结果，在顺向房室折返性心动过速期间对冠状窦及其分支进行了检查。最早的局部激动出现在后外侧分支分叉处的真正冠状窦腔内。在此区域施加射频能量导致预激消失。在定位左间隔和后旁道时，先前的研究表明，II导联阴性且AVR导联阳性的心室预激对于心外膜下位置具有高度敏感性和特异性。因此，对冠状窦及其分支进行检查可能无需进入左心室即可进行有效消融。
