Neuser H, Hofmann E, Ebeling F, Remp T, Steinbeck G
Abteilung für Kardiologie Salzburger Leite 1, Bad Neustadt a. d. Saale.
Z Kardiol. 1996 Aug;85(8):596-602.
A 43-year-old man with a 30-year history of WPW-syndrome and a hypertrophic cardiomyopathy developed acute heart failure after onset of atrial fibrillation with fast antegrade conduction, which could be converted to sinus rhythm with antiarrhythmic medication. Catheterization of the coronary sinus during EP testing demonstrated a persistent left superior vena cava. The accessory pathway could be localized at the orifice of an atypical epicardial vein. It was successfully abolished after subvalvular placement of the electrode catheter in the left ventricle. This constellation indicates a combined defect during the regression of the sinus venosus to the sinus coronarius with persistence of conducting muscle fibers. Successful RF ablation procedure provides an obvious risk reduction as a result of a lower frequency of atrial fibrillation and the eliminated risk of ventricular fibrillation due to rapid conduction via an accessory pathway. Beyond that, harmless therapeutic treatment of hypertrophic cardiomyopathy with a calcium-channel-blocker (verapamil type) can follow RF ablation.
一名患有预激综合征（WPW）30年且伴有肥厚型心肌病的43岁男性，在房颤伴快速前向传导发作后出现急性心力衰竭，使用抗心律失常药物可将其转为窦性心律。电生理检查期间对冠状窦进行导管插入术显示存在持续左上腔静脉。附加旁道可定位于一条非典型心外膜静脉的开口处。在左心室瓣膜下放置电极导管后，该旁道被成功消除。这种情况表明在静脉窦向冠状窦退化过程中存在联合缺陷，伴有传导肌纤维持续存在。成功的射频消融手术可降低房颤发生频率，消除因旁道快速传导导致室颤的风险，从而显著降低风险。除此之外，射频消融后可使用钙通道阻滞剂（维拉帕米类）对肥厚型心肌病进行无害的治疗。
