Haissaguerre M, Marcus F, Poquet F, Gencel L, Le Métayer P, Clémenty J
Hôpital Cardiologique du Haut-Lévêque, Bordeaux-Pessac, France.
Circulation. 1994 Sep;90(3):1124-8. doi: 10.1161/01.cir.90.3.1124.
Accessory pathways may be located in close proximity to the His bundle, resulting in a high risk of heart block during attempted surgical or electrical interruption of these pathways. This study reports the prevalence, ECG characteristics, and results of catheter ablation of parahissian accessory pathways. They were defined on the basis of both the presence of a high amplitude (> 0.1 mV) of His bundle potential at the ablation site and an exclusion of anteroseptal or midseptal location of the accessory pathway.
Eight patients with a parahissian accessory pathway were identified among 582 consecutive patients who underwent radiofrequency ablation of an accessory pathway. They were six males and two females with a mean age of 21 +/- 9 years. During maximal preexcitation, the ECG showed a positive delta wave in leads I, II, and a VF in all patients: six had a negative delta wave in leads V1 and V2 instead of the positivity usually observed in anteroseptal accessory pathways. This pattern had a sensitivity of 75%, a specificity of 96%, a positive predictive value of 86%, and a negative predictive value of 93% for a parahissian location in comparison with a group of 28 patients with anteroseptal accessory pathways. At the successful ablation site, the mean amplitude of the His bundle potential was 0.2 +/- 0.1 (0.12 to 0.4 mV). All accessory pathways were successfully ablated without causing heart block using 5 to 20 W of radiofrequency energy.
Parahissian accessory pathways have a preexcitation pattern that is distinctive from that of anteroseptal accessory pathways. Catheter ablation of these pathways is feasible using low energy with preservation of normal atrioventricular conduction.
旁希氏束旁道可能紧邻希氏束，在试图通过手术或电方法阻断这些旁道时，发生心脏传导阻滞的风险很高。本研究报告了希氏束旁旁道的发生率、心电图特征及导管消融结果。这些旁道的定义基于消融部位希氏束电位高振幅（>0.1mV）的存在以及旁道排除在前间隔或中间隔位置。
在582例连续接受旁道射频消融的患者中，识别出8例希氏束旁旁道患者。他们中6例男性，2例女性，平均年龄21±9岁。在最大预激时，所有患者心电图在I、II导联及aVF导联显示正向δ波：6例患者V1和V2导联为负向δ波，而非前间隔旁道通常所见的正向。与28例前间隔旁道患者相比，这种模式对希氏束旁位置的敏感性为75%，特异性为96%，阳性预测值为86%，阴性预测值为93%。在成功的消融部位，希氏束电位的平均振幅为0.2±0.1（0.12至0.4mV）。使用5至20W射频能量，所有旁道均成功消融，未导致心脏传导阻滞。
希氏束旁旁道具有与前间隔旁道不同的预激模式。使用低能量进行这些旁道的导管消融是可行的，且能保留正常房室传导。
