导管消融冠状窦副通路后再入性房性心动过速

Q4 Medicine

Journal of Cardiology Cases Pub Date : 2025-08-01 DOI:10.1016/j.jccase.2025.05.004

Koichi Watanabe MD, Hidehiro Iwakawa MD, PhD, Ken Terata MD, PhD, FJCC, Hiroyuki Watanabe MD, PhD, FJCC

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引用次数: 0

摘要

一些患者需要在冠状窦（CS）内进行射频导管消融（RFCA）以消除通过副通路（APs）的传导。一名23岁的男性被诊断为房室折返性心动过速（AVRT），使用左侧AP作为逆行肢体，并在CS内通过RFCA成功治疗。在RFCA之后，观察到另一种形式的窄性QRS复合心动过速，电生理学研究显示心动过速为累及CS的再入性房性心动过速（AT）。CS内的射频消融术成功终止了心动过速。这是AVRT继发于RFCA的医源性再入性AT的第一例。学习目的射频导管消融（RFCA）是治疗由辅助通路引起的房室重入性心动过速（AVRT）的标准方法。本病例强调，接受广泛射频治疗的AVRT患者可能会发生复发性再入性房性心动过速。操作者需要意识到，广泛的射频应用可能产生致心律失常的底物，即使在AVRT患者中也是如此。

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Reentrant atrial tachycardia after catheter ablation of coronary sinus accessory pathway

Some patients require radiofrequency catheter ablation (RFCA) within the coronary sinus (CS) to eliminate conduction through accessory pathways (APs). A 23-year-old man was diagnosed with atrioventricular reentrant tachycardia (AVRT) utilizing a left-sided AP as the retrograde limb and was successfully treated by RFCA within the CS. Following the RFCA, another form of narrow QRS complex tachycardia was observed, and an electrophysiology study revealed the tachycardia as reentrant atrial tachycardia (AT) involving the CS. RFCA within the CS successfully terminated the tachycardia. This is the first case of iatrogenic reentrant AT secondary to RFCA for AVRT.

Learning objective

Radiofrequency catheter ablation (RFCA) is the standard treatment for atrioventricular reentrant tachycardia (AVRT) caused by accessory pathways. This case highlights that patients with AVRT who have undergone extensive RF applications may develop recurrent reentrant atrial tachycardia. Operators need to be aware that extensive RF applications can generate arrhythmogenic substrates, even in patients with AVRT.

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