Title: Catheter Ablation of Paroxysmal Supraventricular Tachycardia
Topic: Arrhythmias
题目：突发性心室心动过速的导管消融
话题：心律失常
Perspective: The following are 10 points to remember from this review of catheter ablation of accessory pathways (APs) and atrioventricular nodal reentrant tachycardia (AVNRT):
1. The most common cause for failure to ablate an AP is inadequate localization, often related to an oblique course of the AP.
2. An AP potential, which can be recorded for approximately 90% of APs, is the most specific marker of a successful ablation site.
3. Unusual APs include epicardial anteroseptal APs, epicardial APs anterior or posterior to the aortic root, and epicardial connections between the right or left atrial appendage and the ventricular epicardium.
4. Epicardial anteroseptal APs may be ablatable from the noncoronary aortic cusp where an AP potential is recorded.。
5. When ablating a posteroseptal AP inside the coronary sinus (CS), cryoablation is safer than radiofrequency ablation (RFA) if the closest coronary artery is <5 mm from the ablation site.
6. The rightward inferior extension of the AV node is the most common substrate for the slow pathway (SP) of the AVNRT circuit, and is ablated between the CS ostium and the tricuspid annulus.
融。
7. Junctional ectopy occurs during RFA at almost all successful SP ablation sites, and to avoid AV block, RFA should be immediately discontinued if there is loss of 1:1 ventriculoatrial conduction.
8. The risk of AV block is <0.5% if RFA is limited to sites inferior to the roof of the CS ostium.
9. In approximately 5% of AVNRTs, the leftward inferior extension of the AV node serves as the SP, and successful target sites are found along the roof of the proximal 2-4 cm of the CS.
10. In <1% of AVNRTs, the SP is ablatable only at the inferolateral mitral annulus. 
观点：房室间的窦性心动过速(AVNRT)及附属途径(APs)的导管消融值得注意的10点情况
1.导致消融AP失败的一个最常见的原因是不适当的定位，由于不适当的定位经常会涉及影响AP的流程。
2.据已有记录大约有90%的Aps表明，一条潜在的AP是成功完成消融点的一个最特殊的标志。
3.异常的AP包括心外膜隔前的Aps，心外膜Aps前或晚于主动脉根，左右心房附加物之间的心外膜连接和心室的心外膜。
4.心外膜隔前Aps可能从有记录的AP潜在的非冠状动脉尖端进行消融。
5.当消融CS里面的一条后部间隔的AP时，如果从消融点看最靠近冠状动脉<5 mm，冷切除要比放射性切除安全。
6.对于AVNRT 巡回的SP来说，AV节点右下侧范围是最常见的底层，在CS和三尖瓣环面之间可以被消
7.交叉点异位出现在RFA几乎要成功的SP消融点上，为了避免AV阻塞，如果存在脑室与心房的流失比例为1：1，那么就应该直接停止RFA。
8.如果RFA局限于的点低于CS口的顶部，那么AV阻塞的风险小于0.5%。
9.在大约有5%AVNRTs里，AV节点左下侧的范围服务于SP,沿着CS顶部最接近2-4 cm可以发现目标点。
10.在小于1%的AVNRTs，SP仅仅可以在下侧的冠状的环面消融切除。

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