Miller J M, Harper G R, Rothman S A, Hsia H H
Department of Medicine, Temple University Hospital, Philadelphia, PA 19140.
J Cardiovasc Electrophysiol. 1994 Oct;5(10):846-53. doi: 10.1111/j.1540-8167.1994.tb01123.x.
A male patient with an atriofascicular pathway underwent catheter ablation of the atriofascicular pathway during atrial fibrillation.
The patient had preexcited atrial fibrillation both clinically and repeatedly during electrophysiologic study. A preexcited tachycardia with a 1:1 AV relationship and regular RR intervals was also induced. Catheter ablation of the atriofascicular pathway could only be performed during persistent atrial fibrillation, based on mapping of the pathway's insertion into the right bundle branch. Following successful ablation and cardioversion to sinus rhythm, a regular QRS tachycardia (atrioventricular [AV] nodal reentry) having the same rate, atrial activation sequence, and His-atrial time as the regular preexcited tachycardia noted preablation was initiated. An AV nodal slow pathway modification eliminated this tachycardia. Neither atrial fibrillation nor AV nodal reentry has recurred on follow-up.
This is the first report of atriofascicular mapping and ablation performed exclusively during atrial fibrillation and illustrates the utility of mapping the pathway's ventricular insertion. Other unusual features ("bystander" pathway activation during AV nodal reentry, possible role of the pathway in genesis of atrial fibrillation) are discussed.
一名患有房室旁道的男性患者在房颤期间接受了房室旁道导管消融术。
该患者临床及电生理研究中均反复出现预激性房颤。还诱发了1:1房室关系且RR间期规则的预激性心动过速。基于对旁道插入右束支的标测，仅在持续性房颤期间进行房室旁道导管消融。成功消融并恢复窦性心律后，出现了一种规则的QRS心动过速（房室结折返性心动过速），其速率、心房激动顺序以及希氏束-心房时间与消融前记录的规则预激性心动过速相同。房室结慢径改良消除了这种心动过速。随访期间房颤和房室结折返均未复发。
这是首次仅在房颤期间进行房室旁道标测和消融的报告，说明了标测旁道心室插入部位的实用性。还讨论了其他不寻常特征（房室结折返期间“旁观者”旁道激活，旁道在房颤发生中的可能作用）。
