CAJ | 학술논문

目的报道矫正型大动脉转位(congenitally corrected transposition of the great arteries,ccTGA)合并室上性心动过速(SVT)的电生理特点和射频消融治疗.方法连续入选2007年1月至2012年12月在阜外心血管病医院接受电生理检查及射频消融治疗的5例ccTGA合并SVT患者,收集相关资料并进行随访.结果共有2例房室结折返性心动过速(AVNRT)、2例房室折返性心动过速(AVRT)和1例房性心动过速(AT).所有病例的解剖分型均为内脏正位、心室左攀、主动脉左前位,(S,L,L).其中AT病例和AVRNT中的1例需要2次手术.2例AVNRT病例的慢径消融成功靶点分别为常规的慢径区域(即冠状静脉窦口前缘)和肺动脉根部前房室结下方.2例AVRT病例共有4条位于左侧形态学三尖瓣环的旁路(2条左后间隔隐匿旁路,1条左中间隔隐匿旁路,1条左侧游离壁隐匿旁路).AT病例的起源灶位于希氏束旁,于形态学左心室流出道间隔面消融成功.随访过程中未发现并发症和复发.结论射频消融可以安全有效地治疗ccTGA合并的SVT.术前熟悉ccTGA的解剖异常是消融成功的关键.
목적 보도교정형대동맥전위(congenitally corrected transposition of the great arteries,ccTGA)합병실상성심동과속(SVT)적전생리특점화사빈소융치료.방법 련속입선2007년1월지2012년12월재부외심혈관병의원접수전생리검사급사빈소융치료적5례ccTGA합병SVT환자,수집상관자료병진행수방.결과 공유2례방실결절반성심동과속(AVNRT)、2례방실절반성심동과속(AVRT)화1례방성심동과속(AT).소유병례적해부분형균위내장정위、심실좌반、주동맥좌전위,(S,L,L).기중AT병례화AVRNT중적1례수요2차수술.2례AVNRT병례적만경소융성공파점분별위상규적만경구역(즉관상정맥두구전연)화폐동맥근부전방실결하방.2례AVRT병례공유4조위우좌측형태학삼첨판배적방로(2조좌후간격은닉방로,1조좌중간격은닉방로,1조좌측유리벽은닉방로).AT병례적기원조위우희씨속방,우형태학좌심실류출도간격면소융성공.수방과정중미발현병발증화복발.결론 사빈소융가이안전유효지치료ccTGA합병적SVT.술전숙실ccTGA적해부이상시소융성공적관건.
Objective To report electrophysiological characteristics and radiofrequency catheter ablation (RFCA) of supraventricular tachycardia (SVT) in patients with congenitally corrected transposition of the great arteries(ccTGA).Methods We included 5 consecutive patients with ccTGA complicated by SVT who were managed by RFCA in our center between January 2007 and December 2012.Then they were followed up.Results This case series consisted of 2 atrioventricular nodal reentrant tachycardia(AVNRT),2 atrioventricular reentrant tachycardia (AVRT) and 1 atrial tachycardia (AT).All 5 patients had "S,L,L" type ccTGA.One AVNRT case and the AT case required a re-do ablation.For AVNRT cases,the slow pathways were successfully ablated in one patient at conventional slow pathway region and in the other,in the proximity to anterior atrioventricular node below pulmonary artery.For AVRT cases,totally 4 accessory pathways(2 posteroseptal concealed,1 mid-septal manifest and 1 free wall concealed)were eliminated at the left-sided tricuspid annuli in the 2 cases.For the AT patient with para-hisian focus,the origin was refractory to ablation both from right and left septum,and was finally eliminated from the septal aspect of morphological left ventricular out-flow tract,which,due to the L-transposition of great arteries,was just aposed to His electrogram recording region.None of the patients had peri-procedural complications,and no recurrences were observed during follow-up period.Conclusion SVT with ccTGA can be effectively and safely managed by RFCA.The familiarity with this special anatomical abnormality prior to procedure was critical for success.