常规射频消融失败的右侧房室旁路消融方式的探讨

Objective: To review and summarize the patients with right-sided accessory pathways(RAPs) resistant to conventional catheter ablation in our center in recent 3 years, providing reference for the ablation treatment of complex right side bypass. Methods: Eleven patients with RAPs who had previously failed with conventional radiofrequency ablation and (or) recurrence after ablation from January 2019 to December 2021 in the Department of Cardiology of the Second Affiliated Hospital of Xi'an Jiaotong University were enrolled. Results: All 11 patients were ablated successfully immediately. Seven cases were successfully ablated by using irrigated-tip catheters, including one case of dextrocardia with intracardiac echocardiography (ICE) to guide the three-dimensional reconstruction of the heart cavity and catheter operation. Four cases were successfully ablated after replacing the Agilis sheath for which traditional SR0 was difficult to reach the target, including 3 patients ablated under the tricuspid valve. The mean number of radiofrequency ablation applications was 7.5 ± 3.4, and the mean time from the ablation start to accessory pathways (AP) conduction block was (7.1 ± 3.0) seconds. Bidirectional AP conduction block was the endpoint. Patients were free of tachycardia or recurrence of AP conduction during a median follow-up of (18.3 ± 12.3) months. No complications were found during the procedure or follow-up period. Conclusion: The application of irrigated-tip catheters, Agilis sheath, ICE and radiofrequency ablation under the tricuspid valve has improved the success rate of RAPs, especially for those complex RAPs with partially failed ablation, relapsed cases or complicated anatomical abnormalities.