Riva S, Tondo C, Carbucicchio C, Fassini G, Della Bella P
Istituto di Cardiologia, Università degli Studi, Fondazione Monzino, IRCCS, Milano.
Cardiologia. 1997 Oct;42(10):1059-65.
Failure of radiofrequency catheter ablation for atrioventricular reciprocating tachycardia may be related to imprecise location of accessory pathways. We have tested the safety and efficacy in improving successful rate of the procedure of a new technique of epicardial mapping of the atrioventricular sulcus by means of a small diameter (2.5F) 16 polar electrode catheter with a soft tip and a minor interelectrode and intercouple distance (2-6-2). The catheter was advanced via a right femoral approach into the coronary sinus or its branches, and the right coronary artery. We report 5 patients who underwent epicardial mapping-guided radiofrequency catheter ablation who had been previously treated with 1 or more (range 1-4) unsuccessful traditional mapping of the atrioventricular sulcus. Epicardial mapping was performed by means of selective catheterization of the coronary sinus in 4 cases, and of the right coronary artery in 1. The accessory pathways was precisely localized and ablated in all patients (mean 8 +/- 1.5 radiofrequency pulses, and 32 +/- 6 min fluoroscopy duration). No procedure or catheterization-related complications were observed. In conclusion, the technique of epicardial mapping used in this study proved to be safe and effective in localizing accessory pathways in selected cases, thereby enhancing radiofrequency catheter ablation success rate. The main advantage of this atraumatic catheter as compared to the traditional ones are the femoral approach and the possibility to advance the catheter to the most anterior aspect of the great cardiac vein. The epicardial mapping is thus a feasible alternative to traditional mapping, particularly in cases in which previous procedures have failed due to a complex arrhythmogenic substrate and or congenital abnormalities.
房室折返性心动过速的射频导管消融失败可能与旁路定位不准确有关。我们通过一种小直径（2.5F）、带有软头、电极间距和耦合间距较小（2 - 6 - 2）的16极电极导管，对房室沟的心外膜标测新技术在提高手术成功率方面的安全性和有效性进行了测试。该导管经右股动脉途径推进至冠状窦或其分支以及右冠状动脉。我们报告了5例接受心外膜标测引导下射频导管消融的患者，他们之前接受过1次或更多次（范围为1 - 4次）不成功的传统房室沟标测。4例通过选择性冠状窦插管进行心外膜标测，1例通过右冠状动脉插管进行。所有患者的旁路均被精确定位并消融（平均8 ± 1.5个射频脉冲，透视时间32 ± 6分钟）。未观察到与手术或插管相关的并发症。总之，本研究中使用的心外膜标测技术在特定病例中定位旁路时被证明是安全有效的，从而提高了射频导管消融的成功率。与传统导管相比，这种无创导管的主要优点是经股动脉途径以及能够将导管推进至心大静脉的最前方。因此，心外膜标测是传统标测的一种可行替代方法，特别是在先前手术因复杂的致心律失常基质和/或先天性异常而失败的情况下。
