Triệt phá đường dẫn truyền phụ vùng dưới vách bằng sóng RF (ablation of posteroseptal AP)

Bệnh viện trung ương Quân đội 108 Viện tim mạch Triệt phá đường dẫn truyền phụ vùng vách sóng RF (Ablation of Posteroseptal AP) Bs Phạm Trường Sơn Posteroseptal AP :Inferoseptal AP (inferior to the true septal) The most complex: Pyramid space, confluence of chamber - Superior: Central fibrous - Anterior:Ventricular septum - Posterior: left and Right Atria - TV is mm to MV: + right atrium- left Ventricle space (thin tissue: AP inside) + CS os: at the superior (ablation site) courses: Right to right, Right to left (common) Left to left, CS to left , CS to Diverticulum Ablated at: the MV ring , TV ring, inside CS ECG characteristic 1/ Negative delta waves in leads III, aVF (less common) positive delta waves in I and aVL 2/Retrograde P’ waves : - Negative in the leads II, III, aVF - Positive in AVR ,AVL 3/ Slow and decremental retrograde conduction: incessant tachycardia - Permanent junctional reciprocating tachycardia(PJRT) EP Studying: During AV reentrant tachycardia, the earliest atrial activation usually is recorded from + The ostium of the coronary sinus + The proximal coronary sinus within cm (those beyond 1–2 cm are considered as left free-wall pathways: leftsided endocardial approach) Functional left bundle branch block during tachycardia results in either no change or only a nominal prolongation of the VA interval (10 to 30 msec) - Functional right bundle branch block usually does not affect the VA interval Differentiation with SS-AVNRT (long VA time) - Advanced A during His refractoriness - Terminate tachy by PVC not conduct to A - Parahisian pacing: No change Stim to A - VA (V pacing and Tachy)< 85ms - VOD (PPI – CL)