Heart Institute, Cedars Sinai Medical Center, Los Angeles, California; Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, People's Republic of China.
Heart Institute, Cedars Sinai Medical Center, Los Angeles, California.
Heart Rhythm. 2018 May;15(5):688-695. doi: 10.1016/j.hrthm.2017.12.025. Epub 2017 Dec 24.
There remains some confusion delineating the accurate location and the detailed anatomical relationship between atrioventricular accessory pathways (APs) located in the superoparaseptal region.
The purpose of this article was to detail the anatomical relationship and accurate location of APs located in the superoparaseptal region.
Between May 1, 2009 and November 30, 2016, 11 patients with superoparaseptal APs (SPS-APs) were identified in 129 consecutive patients who underwent catheter ablation for APs in our center.
A single SPS-AP was detected in all patients (manifest, n = 5; concealed, n = 6). The location of all 11 APs were precisely identified at the region millimeters superior to the His bundle recording site at the tricuspid annulus (S-HB, n = 6; manifest, n = 4); the area millimeters behind the His bundle recording site, adjacent to the right atrial aspect of the noncoronary aortic cusp (B-HB, n = 2; manifest, n = 1); and the true para-His bundle region (P-HB, n = 3). The electrocardiogram of all 5 manifest APs conformed to the typical "anteroseptal AP" pattern: a positive delta wave in leads I, II, avF, and avL; a narrow positive delta wave in lead V; and a precordial QRS transition at lead V. All APs were successfully eliminated by catheter ablation. After 54 ± 26 months of follow-up, all patients were free of arrhythmia.
Three distinct regions are identified for localization of SPS-APs. Careful mapping and a detailed understanding of the anatomy of this region as well as distinct electrocardiographic characteristics are essential to eliminate such APs safely and effectively.
房室旁路（AP）位于房室结上间隔区时，其准确位置和详细解剖关系仍存在一些混淆。
本文旨在详细描述位于房室结上间隔区的 AP 的解剖关系和准确位置。
2009 年 5 月 1 日至 2016 年 11 月 30 日，我们中心对 129 例 AP 患者进行了导管消融治疗，其中 11 例患者存在房室结上间隔区 AP（SPS-AP）。
所有患者均检测到单个 SPS-AP（显性，n=5；隐匿性，n=6）。所有 11 个 AP 的位置均精确地确定在三尖瓣环上希氏束记录部位毫米以上（S-HB，n=6；显性，n=4）；希氏束记录部位后毫米处，毗邻无冠窦主动脉瓣瓣环的右房面（B-HB，n=2；显性，n=1）；以及真正的房室结旁希氏束区（P-HB，n=3）。所有 5 例显性 AP 的心电图均符合典型“前间隔 AP”模式：I、II、avF 和 avL 导联上的正向 delta 波；V 导联上的窄正向 delta 波；V 导联上的心前区 QRS 过渡。所有 AP 均通过导管消融成功消除。随访 54±26 个月后，所有患者均无心律失常。
确定了 3 个不同的区域来定位 SPS-AP。仔细的标测和对该区域解剖结构的详细了解以及明显的心电图特征对于安全有效地消除此类 AP 至关重要。
