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2002 16 2 81 ( ) ( ) : ( ) : R541. 7 A 1007 2659 (2002) 02 0081 15 (RFCA) 1991,, (AVJRT) ( ) 2000 (136 ), ( ) ( [ 96. 6 %, 2. 8 % ]), CHF, 0.

1 ( ) ( ) : ( ) : R A (2002) (RFCA) 1991,, (AVJRT) ( ) 2000 (136 ), ( ) ( [ %, 2. 8 % ]), CHF, 0. 9 % [1 ] 1996, (3) ( ) RFCA (4) ( ), ( ) [2 ] 6 (5) RFCA, RFCA, ), RFCA (1) (2),, RFCA 1 ), (5) RFCA ;, (6) RFCA ; (7), (8) RFCA (1) ( ) (1) (CHF) (2) (AVRT) (6) ( (3) ( ), (4) AVRT AVJRT ( ( ) (9),,, (2)

2 82 ( ) (3) (5), (4),,, (5), [37 ] 1. 2,, b,,, (2) 4, a,, (1) 4 a AVRT, (3),, b, 2, (2) 4 a, , RFCA b AVRT,,,, c d, (3) AVJRT a 7,,, ( ) b 7,, (1) 4 a AVRT, b, ( (2) 4 [8 a, ], 5 ; b AVRT,, c, (3) AVJRT a 7,,, h (1) 4 b 7, (4) AVRT AVJRT, h, a AVRT AVJRT, b AVRT AVJRT, 2. 1 RFCA, RFCA ; ; ; ), ( ) (0. 2 bid 12 w),

3 RFCA, RFCA %, 1. 7 %, ( 1. 0 % [1 ] ), , X, (His ) RFCA h, h ; 6 h, 2 h ,,, (RS 2 His ) 2 h His X, 50150, mg/ d, 13, 2. 2,, ,,,,, 3. 2, RFCA, , 80 %, 20 % h ;,,,, < 9,> 9,,, ; ,,, () ; 50 U/ kg( 2 000, U), 1 h, 2 mg/ kg, 1, 13, ;,,, (, ), X 60 min,, ; 40 min 3,, RFCA,

4 84 ( ), ( EAA) EAA,,EAA A/ V,, ( ), ,,, 5570, 50 W ,,,,, (1015 W) ;,, (2050 W) 510 s, 10 s X, , (RAO) 30, /,, (LAO) 45, His LAO 45, , His,RAO His,, ,,LAO 45, His His , His His (6 ), His ; His His : U, SR 0 SWARTZ ,, His 10 11, SR 0, X SWARTZ U, SWARTZ,, ,, His, SWARTZ SWARTZ SR 0 SR 1 SR 2 SR 3,, SR 4,, His SR 0, ,, ; [9,10 ] 3. 3, His ; QRS ( EVA) (), ( EAA) ;, His

5 , 5 min,, ,, His, His,, His,,, His His His,,, :,, ; EAA, : EAA EAA 5,, ; ms, ;,,, , His AVRT,,,, A, V,X,, His, EAA, 5 s,, ; (A V) ( EVA),,, 510 s s,, (PJRT) [12,13 ], AVRT :a ;b,, () ;c, :a P avf V 2 V 6,aVR ;b RP R :a, , AVRT B ( avf QRS QS ), AVRT, QRS, EVA / EAA, AVRT V A, V A 510 mm, EAA, Mahaim ( ), (atrial2fascicular fiber),,, / [11 ] EAA, ;b PJRT, PJRT [14,15 ]

6 86 ( ),, AVRT,QRS,,, QRS :,,, Delta, Mahaim, Mahaim, Mahaim His ; Mahaim :,,,, Mahaim ;, Mahaim, : Mahaim ( QRS ), Mahaim 511, (atrial2ventricular fiber), (, ),,,, EVA [17, EVA, ] 2 cm 2 QRS, His QRS,, (nodal2ventricular fiber) EVA EAA,,, QRS AVJRT,,, 1 1, QRS,, Mahaim , QRS, AVRT AVJRT AVRT AVRT, His,, 4 AVJRT Mahaim, [ Ebstein ] 5 %20 %Eb2 stein, 4. 1 Ebstein ,, (His ) His RFCA, : ( ) His : Ebstein AVRT, ( ) His, ; V ;, S 1 S 2 S 1 S 2 S 3 Ebstein S 1 S 1,,,,,, 2000 RFCA,AVJRT RFCA %, 2. 3 %, 0. 8 % [1 ], : AVJRT,

7 , : AVJRT ;, His 5560 ;, A 1530 W,,, 1520 s AVJRT, 60 s,, ( ), AVJRT, ; ,, 12 : AVJRT,,,,,, AVJRT,, AVJRT AVJRT, AVJRT, : ( > 130 / ) AVJRT95 % ; AVJRT, His, VA, AVJRT AVRT, VA :VA, His VA A AVRT AVJRT AVJRT VA His,VA 1 1,,VA 1 2 1,,, VA, VA 1 1, His 4. 2,, SR 0 PR : SWARTZ, [18,19 ] RAO 30 LAO 45 RAO 30, ( ) ( ) (His ) ( ) ;LAO 45 ( ) ( ) LAO ,, AVJRT;, ;, 4. 3 His 3, 1/ 3 1/ 3, ,, : AVJRT( ) ; A V ;, AVJRT; His ; AVJRT : 5,, ( [24 LAO 45 AVJRT ) ], 5 % RFCA 4. 4 [2023 ] ,,,,V A = 1 1 VA 0 ms, VA, VA, ;, 50 %90 %, < 1 % 10 %30 %,

8 88 ( ) ( 4 mm 8 mm, 2040 W ),5570 LAO 45, 56,, A V ; RAO 30 [25,26 ] 2, 3060 s,, 34 mm, > 90 %, < 10 %, ( ), RFCA,,,, LAO RFCA, [34 50 %, ] 2 5 %,, 50 %, :, 20 % ; 6 %25 %, < 10 % RFCA,, min, His 5. 3 AVJRT AVRT , [2729 ] [35,36 ],, CAR2, TO His A, 12 (channel), 1, A, A P 25 ms, P T ( ), s, 2030 P T, ( ) W 5570,, 60 s,, 60 s A QS ( s, 2030 W 5560, (10 s ),min 60 s, 60 s ( ) 30 :, min ; , ;, ;,, [ ], ) X ( ICE),,, 34 cm ( 1/ 3 ) [3740 ] ( ), 10 20

9 W 5570, +, 3060 s (20 %, 30 %), 6090 s,, +, , 30 % H 20, ( P ) 40 W, 10 s, PR [4149 ] s, 12 ( ) His : : 80 /, (foci) :, 90 (PVP) PVP / 120 /,, 30 min PVP, 6 PVP ( ), 6. 1 /, 2000 RFCA, PVP, RFCA ( ), %, 5. 4 %, 0. 8 % [1 ], , 2030 W, 3060 s : 3 4, , ( ) ;, 3 (14), 2 avf R, ( ) 2 QRS ( ) R ( ),avl QS, QRS , / ; PVP avf QRS PVP avl QRS 5. 6 RFCA , [5052 ],, 12, 30 s min : 48 h,, ;,,QRS 90 %, 2 %,, 0. 1 %, ,,,, avf QRS R, :, 60 %85 %, QRS, QS RS ; V 1 r [5360 ], ,QRS s

10 90 ( ) ; V 1 V 3 R,R 1 > :, R 2 < R 3 ; V 5 V 6 QRS s S 1 S 1,, 150 /, QRS,,X LAO 45 LAO 45, QRS,,,, RAO ,, ,, X RAO QRS 30 LAO 45,RAO 30 :,,LAO 45, ,X LAO ,, (Pur) QRS,, Pur Pur QRS 20 ms, H ( His ) ( 70 His ) Pur, Pur, Pur Pur, ,, Pur,, Pur 15 s,, His,, Pur ; His ; Pur, Pur, His,, His ;, His Pur, His Pur (, His ), 5 s,, Pur QRS, Pur His, Pur, His , QRS 20 ms,, :, 12, , 55 His : ,,, [6167 ]

11 ,,,, 30 %70 % 68 % (AVRD),, AVRD, QRS 100 % ,,,, (CARTO ),,,,, ,,,, 6070 ( 40, 45 ) ,, : : QRS ; ( ; V His ( H) (RB) ; HV, HV ; VV HH, RB2RB, : RB,,, 1530 W, 5570, 4060, s AVRD ARVD,RFCA,,,, [6870 ] 7 RFCA , , + (,, ), ,, ( mmhg),,,,,,,,, 12 ) ; ; ; ,, ,, ( ), ,, :, 12 mg ;, X

12 92 ( ), 500, ml ;, 7. 5 X ,,, ,,, CT/ / ( < 30 %) ,, ( 300 ml ) 1 h, ,, ;, ; : AVJRT; ; ; ; ; ( His ) ; His ;, , : ,, :,, 6 ( 3 s > 40 / ) 7. 3,,,,, 6 h 12 h h 0. 1 %, ,, mg ( ), ,,,,, 7. 6 ;, ;,,

13 ,,, CARTO, 35,, (PT) ( INR) 6 h RFCA,RFCA PT INR ,, 1, , [J ].,2001,15 : , [J ].,1996,10 : Perry JC,Garson A. Supraventricular tachycardia due to WPW syndrome, in children :early disappearence and late recurrence[j ].J Am Coll Car2 diol,1990,16 : ,., [J ].,2001,9 :3 5 Van Hare G. Indications for radiofrequency ablation in pediatric popula2,,tion[j ].J Cardiovasc Electrophysiol,1997,8 :952 6,,,. His, His [J ].,1998,2 :181 [7174 ] 8 2, 7,,,. 240 [J ].,2000,38 : CARTO 8,,,. CARTO X, [J ].,2001,15 :92, 9,,,. 561 CARTO [J ].,1994,22 :14, 10,,,. [J ].,1996,24 :390 CARTO : 11 Sun Y,Po SS,Arruda M,et al. Risk of coronary artery stenosis with ve2, nous ablation for epicardial accessory pathways. PACE,2001,24 (pt ) : 605, CARTO 12,,,. [J ].,1995,3 :3, ; 13,,,., [J ].,1995,23 :249 ; 14 Miller JM,Rothman SA,Hsia HH,et al. Ablation of Mahaim Fibers. In : Huang SKS,Wilber DJ eds. Radiofrequency catheter ablation of cardiac arrhythmias: basic concepts and clinical applications[ M]. 2nd ed. New 8. 2 York :Futura Publishing Company,Inc, ,,,. Mahaim, CARTO :1 [J ].,1996,24 :19, ( 16,,,. ) :8 [J ].,1995,23 :364, 17,,,. [J ].,1994,8 :185, 18,,,. SR0, [J ].,

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