Cappato R, Schlüter M, Weiss C, Willems S, Meinertz T, Kuck K H
Second Department of Internal Medicine, St. Georg Hospital, Hamburg, Germany.
J Cardiovasc Electrophysiol. 1997 Apr;8(4):371-6. doi: 10.1111/j.1540-8167.1997.tb00802.x.
Local electrograms recorded from the coronary sinus and great cardiac vein provide important information for the diagnosis of various arrhythmias and identification of target sites for ablation of left-sided accessory pathways. One limitation of present techniques is the inability, in many cases, to probe the great cardiac vein at the anterior mitral annulus. We tested the feasibility of a new technique for catheterization of the coronary sinus and great cardiac vein by means of a small-diameter electrode catheter advanced via a right femoral approach through an angiography catheter.
Of 22 patients (12 men and 10 women; ages 44.5 +/- 13.4 years) undergoing radiofrequency ablation of a supraventricular tachycardia, cannulation of the coronary sinus orifice using a 6-French 1L or 2L Amplatz catheter was achieved in 20 patients (91%) within 0.9 +/- 0.6 minutes; after cannulation, a 2-French octapolar electrode catheter with a soft radiopaque tip and a 3-mm interelectrode distance could be advanced in all 20 patients through the guiding catheter to the great cardiac vein in the anterior region of the AV sulcus within 0.8 +/- 0.7 minutes. Atrial and ventricular local potentials were recorded all along the mitral annulus during sinus rhythm, atrial and ventricular pacing, or supraventricular tachycardia. Variation of local potential amplitude never exceeded 20% of the mean and presented similar stability at all annular regions. The arrhythmogenic substrate was identified in all patients. Of 18 patients with 21 left-sided accessory pathways, an accessory pathway potential could be recorded at the ablation site by one or more adjacent epicardial electrode pairs in 10 pathways. No procedure-related complications were observed.
The technique introduced in this study proved feasible in 91% of patients. Its main advantages are the simplicity and rapidity of coronary sinus cannulation and the ability to advance the electrode catheter to the anterior cardiac vein. In addition, closely spaced bipolar electrograms resulted in enhanced atrial, ventricular, and accessory pathway potential resolution.
从冠状窦和大心脏静脉记录的局部电图为各种心律失常的诊断以及左侧旁路消融靶点的识别提供了重要信息。当前技术的一个局限性在于，在许多情况下无法探测二尖瓣前环处的大心脏静脉。我们通过经右股动脉途径将小直径电极导管经血管造影导管推进，测试了一种用于冠状窦和大心脏静脉插管的新技术的可行性。
在22例接受室上性心动过速射频消融的患者（12例男性和10例女性；年龄44.5±13.4岁）中，20例患者（91%）在0.9±0.6分钟内使用6F 1L或2L Amplatz导管成功插管冠状窦口；插管后，所有20例患者均可在0.8±0.7分钟内通过引导导管将带有软质不透射线尖端且电极间距为3mm的2F八极电极导管推进至房室沟前部区域的大心脏静脉。在窦性心律、心房和心室起搏或室上性心动过速期间，沿二尖瓣环全程记录心房和心室局部电位。局部电位幅度变化从未超过平均值的20%，且在所有瓣环区域表现出相似的稳定性。所有患者的致心律失常基质均得以识别。在18例有21条左侧旁路的患者中，10条旁路在消融部位可通过一个或多个相邻的心外膜电极对记录到旁路电位。未观察到与手术相关的并发症。
本研究中介绍的技术在91%的患者中证明是可行的。其主要优点是冠状窦插管简单快速，且能够将电极导管推进至心脏前静脉。此外，紧密间隔的双极电图提高了心房、心室和旁路电位的分辨率。
