Klein L S, Hackett F K, Zipes D P, Miles W M
Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis 46202-4800.
Circulation. 1993 Mar;87(3):738-47. doi: 10.1161/01.cir.87.3.738.
The purpose of this study was to test the feasibility of radiofrequency catheter ablation of Mahaim fibers at the tricuspid annulus.
Four patients who fulfilled criteria for having Mahaim fibers and preexcited reciprocating tachycardia underwent radiofrequency catheter ablation. Three patients had atriofascicular connections, and one patient had an atrioventricular connection. The mean age was 27 years (age range, 11-48 years). All patients had highly symptomatic tachycardias, producing syncope in one patient and presyncope in the remaining three patients. Symptoms were present for a mean of 13 years (range, 4-23 years). All pathways conducted only anterogradely, and preexcitation resulted in a left bundle branch block QRS morphology. Adenosine caused block in the accessory pathway in the three patients in whom it was tested. The stimulus to delta interval increased by 75 msec (range, 35-90 msec) during rapid atrial pacing. The atrial insertion of the Mahaim fiber was in the right lateral atrium in one patient, right posterolateral atrium in two patients, and right posterior atrium in one patient. The ventricular insertion was in the distal right bundle branch in three patients and in the posterolateral right ventricle near the tricuspid annulus in the patient with an atrioventricular connection. Stimulus to delta wave mapping was used to help localize the atrial insertion of the atriofascicular connections. A mean of 15 radiofrequency pulses (range, 10-19 pulses) delivered to the tricuspid annulus in the posterior to lateral regions eliminated accessory pathway conduction in all patients. No complications occurred. Tachycardia did not recur during a mean follow-up of 8 months (range, 2-15 months).
Radiofrequency current applied to the tricuspid annulus can safely eliminate tachycardia in patients with Mahaim fibers.
本研究的目的是测试在三尖瓣环处进行Mahaim纤维射频导管消融的可行性。
4例符合Mahaim纤维及预激性折返性心动过速标准的患者接受了射频导管消融。3例患者有房室束旁连接，1例患者有房室连接。平均年龄为27岁（年龄范围11 - 48岁）。所有患者均有高度症状性心动过速，1例患者出现晕厥，其余3例患者出现先兆晕厥。症状平均持续13年（范围4 - 23年）。所有旁路仅前传，预激导致左束支阻滞QRS形态。腺苷在3例接受测试的患者中导致旁路阻滞。快速心房起搏期间，刺激到δ波间期增加75毫秒（范围35 - 90毫秒）。1例患者Mahaim纤维的心房插入点位于右外侧心房，2例患者位于右后外侧心房，1例患者位于右后心房。3例患者的心室插入点位于右束支远端，房室连接患者的心室插入点位于三尖瓣环附近的右心室后外侧。刺激到δ波标测用于帮助定位房室束旁连接的心房插入点。在后外侧区域的三尖瓣环平均施加15个射频脉冲（范围10 - 19个脉冲），消除了所有患者的旁路传导。未发生并发症。平均随访8个月（范围2 - 15个月）期间心动过速未复发。
应用于三尖瓣环的射频电流可安全消除Mahaim纤维患者的心动过速。
