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目的 评价 2 8例右前隐匿性房室旁路 (右前旁路 )的电生理特点和射频消融治疗。 方法 分析房室折返性心动过速 (atrioventricular reentrant tachycardia,AVRT)的体表心电图和经食管心电图逆行 P波特点 ,比较消融前后的室房 (VA)传导变化。 结果 2 8例患者 AVRT的 、 、a VF导联逆行 P波均为直立正向 , 和 a VL 导联逆行 P波可直立 (15例 )或负向 (13例 ) ,V1 导联逆行 P波均为负向 ,2 0例 V1 的逆行 P波与 QRS终末部相连而呈 r Sr′型。心室程序刺激 14例显示 VA传导恒定 ,14例表现部分 (10例 )或完全 (4例 ) VA递减传导 ,其中 10例为未成年患者。 2 8例有效消融靶点位于三尖瓣环前上部 (左前斜位的 9～ 11点 )。 14例 VA传导恒定者右心室起搏下标测和消融 ,旁路传导阻断后VA分离 ;14例 VA递减传导者诱发 AVRT标测和消融 ,旁路阻断后有较强的正常 VA逆传。 结论 、 、a VF导联逆行 P波直立正向 ,V1 导联逆行 P波负向是右前旁路参与 AVRT的重要心电图特点。部分患者 (尤其是未成年者 )正常 VA传导能力较强 ,诱发 AVRT、标测和消融易获成功
Objective To evaluate the electrophysiological characteristics and radiofrequency ablation of 28 cases of right anterior chamber occlusion (right anterior bypass). Methods The surface electrocardiogram (ECG) and retrograde P wave characteristics of atrioventricular reentrant tachycardia (AVRT) were analyzed to compare the changes of VA before and after ablation. Results The retrograde P wave of AVRT, a VF in 18 patients were all upright positive, and retrograde P wave in a VL was erect (15 cases) or negative (13 cases). V1 lead retrograde P wave Are negative, 20 cases of retrograde P V1 V1 connected with the terminal was r Sr ’type. Ventricular program stimulation in 14 cases showed constant VA conduction, 14 cases showed partial (10 cases) or complete (4 cases) VA decreased conduction, of which 10 cases were juvenile patients. Twenty-eight effective ablation targets were located in the anterior superior tricuspid annulus (9-11 points in the left anterior oblique position). 14 cases of constant conduction VA right ventricular pacing and ablation, VA isolated after bypass block; 14 cases of VA decreased conduction AVRT mapping and ablation, bypass the block after a strong normal VA inverse pass. CONCLUSIONS: A retrograde P wave in a VF leads to an upright positive and a retrograde P lead in V1 lead is an important ECG characteristic of right anterior bypass in AVRT. Some patients (especially minors) normal VA conduction ability, induced AVRT, mapping and ablation is easy to succeed