Casella Michela, Dello Russo Antonio, Fassini Gaetano, Andreini Daniele, De Iuliis Pasquale, Mushtaq Saima, Bartoletti Stefano, Riva Stefania, Tondo Claudio
Michela Casella, Antonio Dello Russo, Gaetano Fassini, Stefano Bartoletti, Stefania Riva, Claudio Tondo, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy.
World J Cardiol. 2013 Feb 26;5(2):8-11. doi: 10.4330/wjc.v5.i2.8.
We report the case of a 14-year-old boy with ventricular preexcitation. A standard, fluoroscopy guided, ablation procedure was successfully performed in a postero-midseptal region with a total fluoroscopy time of about 45 min (2430 cGy.cm(2)). A few hours after the procedure, preexcitation reappeared. A second ablation procedure was scheduled using the EnSite NavX™ mapping system. During mapping along the tricuspid groove, preexcitation suddenly disappeared due to mechanical "bumping" of the accessory pathway and it did not recover over the next 30 min. As per our routine practice, the phase of geometry reconstruction has been continuously recorded by the system; thus, an off-line analysis allowed to pinpoint the site of earliest activation and the site of mechanical bumping, where radiofrequency obtained the accessory pathway ablation. The second procedure was performed without using fluoroscopy at all. Thanks to the geometry reconstruction, the procedure was completely successful thus avoiding a further rehospitalization.
我们报告了一例14岁患有心室预激的男孩的病例。在荧光透视引导下，于后中隔区域成功进行了标准的消融手术，总荧光透视时间约为45分钟（2430 cGy.cm(2)）。术后数小时，预激再次出现。计划使用EnSite NavX™标测系统进行第二次消融手术。在沿三尖瓣环沟进行标测时，由于旁路的机械性“碰撞”，预激突然消失，且在接下来的30分钟内未恢复。按照我们的常规操作，系统持续记录了几何重建阶段；因此，离线分析能够确定最早激动部位和机械碰撞部位，在此处进行射频消融成功阻断了旁路。第二次手术完全未使用荧光透视。得益于几何重建，手术完全成功，从而避免了再次住院。
