Bernadic M, Hatala R, Kaltenbrunner W, Tysler M, Steinbach K, Hulín I
Ustav patologickej fyziológie LFUK, Bratislave, Slovakia.
Bratisl Lek Listy. 1995 Apr;96(4):210-6.
The modern non-pharmacological therapy of the WPW syndrome by means of catheter ablation is based on the interruption of the accessory pathway(-s) by radiofrequency current energy. Destruction of the morphologic substrate of the arrhythmia alters the activation wave spread in the heart.
It was the aim of this report to demonstrate the diagnostic potential of BSM in localizing both overt and concealed accessory pathways. Presented study analyzes the alterations of the cardioelectric field by means of body surface ECG mapping in two female patients with accessory pathways before and after their successful curative treatment by radiofrequency catheter ablation.
Five patients were analyzed prior and after RF catheter ablation by BSM, two of them were selected for this presentation. One patient with WPW syndrome suffered from frequent supraventricular tachycardia due to in one female patient with an overt accessory pathway. The other patient was for several years incessantly in permanent junctional reentry tachycardia due to a concealed accessory pathway. The examination comprised 12-lead ECG, orthogonal vectorcardiogram according to Frank, BSM using a regular 80-electrode-array system and signal-averaged ECG.
The RF ablation was successful in both patients and their arrhythmia was abolished. By means of a detailed analysis of the ventricular activation prior RF ablation in the patient with WPW syndrome the precise site of the ventricular insertion of the accessory pathway in the left lateral free wall was predicted. Furthermore, alterations of the terminal QRS complex were observed when comparing pre- versus post-ablation maps. In the second patient the atrial insertion of the accessory pathway with retrograde and decremental conduction was successfully localized to the right septal region by means of pre-ablation BSM.
Both ventricular and atrial activation can be in detail analyzed by means of BSM. Such analysis offers more precise information on the spatial component of the activation wave spread. This case report gives further evidence that BSM is a useful method for precise localization of both ventricular and atrial insertion sites of accessory pathways in patients with paroxysmal tachycardias due to this electrophysiologic abnormality. This information gained recently clinical impact since it can be directly used for faster arrhythmogenic substrate targeting during ablation therapy. (Fig. 5, Ref. 17.)
预激综合征的现代非药物治疗方法——导管消融术，是基于利用射频电流能量中断旁路。心律失常形态学基质的破坏改变了心脏中激动波的传播。
本报告旨在证明体表电位标测（BSM）在定位显性和隐匿性旁路方面的诊断潜力。本研究通过体表心电图标测分析了两名患有旁路的女性患者在成功接受射频导管消融治疗前后的心电场变化。
通过BSM对5例患者在射频导管消融术前和术后进行分析，其中2例被选用于本报告。1例预激综合征患者因显性旁路频繁发生室上性心动过速，另1例患者因隐匿性旁路多年来持续发生永久性交界性折返性心动过速。检查包括12导联心电图、根据Frank法的正交矢量心电图、使用常规80电极阵列系统的BSM以及信号平均心电图。
两名患者的射频消融均成功，心律失常消失。通过对预激综合征患者射频消融术前心室激动的详细分析，预测了旁路在左外侧游离壁心室插入的精确部位。此外，比较消融前后的标测图时，观察到终末QRS波群的变化。在第二例患者中，通过消融前的BSM成功将具有逆向和递减传导的旁路心房插入部位定位到右间隔区域。
通过BSM可以详细分析心室和心房的激动情况。这种分析提供了关于激动波传播空间成分的更精确信息。本病例报告进一步证明，对于因这种电生理异常导致阵发性心动过速的患者，BSM是精确定位旁路心室和心房插入部位的有用方法。由于该信息可直接用于消融治疗期间更快地靶向心律失常基质，因此最近已产生临床影响。（图5，参考文献17）
