Cardiology Department, Beijing An Zhen Hospital, Capital Medical University, Beijing, China.
J Cardiovasc Electrophysiol. 2011 May;22(5):499-505. doi: 10.1111/j.1540-8167.2010.01948.x. Epub 2010 Nov 18.
It is difficult to ablate a right-sided accessory pathway (AP) with atrial insertion far from the tricuspid annulus (TA). We report our initial experience of ablating this rare AP by a 3-dimensional electroanatomical mapping system (CARTO).
From January of 2006 to April of 2008, 18 patients with right-sided APs who failed previous outside ablations were enrolled in this study. Retrograde AP conduction was mapped during pacing at the right ventricular apex by activation-mapping the right atrium (RA) using a 3-dimensional electroanatomical mapping system. AP atrial insertion was defined as the earliest retrograde atrial activations and successful ablation of the APs at this site.
Among the 18 patients who had failed previous ablation, 10 patients (7 patients with right manifest APs and 3 patients with right conceal APs) had atrial insertions far from the TA. Of the 10 patients, the atrial insertions were found at the base of the RA appendage in 3 patients, at the high lateral RA in 5 patients, at the low lateral RA in other 2 patients. Ablation at the atrial insertions successfully abolished the AP conduction. The mean distance between the atrial insertion sites and the TA was 20.2 ± 2.7 mm. No patients reported recovered AP conduction or recurrent tachycardias after 6-month follow-up.
The right-sided APs may have atrial insertion far from the TA. These uncommon variation of APs can be reliably identified and ablated using CARTO system.
消融右侧心外膜旁道（AP）时，如果其心房入口远离三尖瓣环（TA），则较为困难。我们报告了使用三维电生理标测系统（CARTO）消融这种罕见旁道的初步经验。
2006 年 1 月至 2008 年 4 月，我们对 18 例既往消融失败的右侧 AP 患者进行了这项研究。通过右心室心尖部起搏进行逆向 AP 传导标测，利用三维电生理标测系统对右心房（RA）进行激活标测。AP 心房入口定义为最早的逆向心房激动点，且在此部位消融 AP 获得成功。
在 18 例既往消融失败的患者中，有 10 例（7 例显性右侧 AP 和 3 例隐匿性右侧 AP）AP 心房入口远离 TA。在这 10 例患者中，有 3 例 AP 心房入口位于右心耳基底，5 例位于 RA 高侧壁，2 例位于 RA 低侧壁。在心房入口处消融成功地消除了 AP 传导。AP 心房入口与 TA 之间的平均距离为 20.2±2.7mm。在 6 个月随访中，无患者报告 AP 传导恢复或复发性心动过速。
右侧 AP 可能有远离 TA 的心房入口。使用 CARTO 系统可以可靠地识别和消融这些不常见的 AP 变异。
