Iturralde Torres P, Colín Lizalde L, Guevara Valdivia M, Rodríguez Chávez L, Kershenovich Shapiro S
Departamento de Electrofisiología, Instituto Nacional de Cardiología Ignacio Chávez INCICH, México, D.F.
Arch Inst Cardiol Mex. 2000 Jul-Aug;70(4):349-66.
Several reports have demonstrated that radiofrequency catheter ablation provides effective control of a variety of supraventricular and ventricular tachycardias. This report details the results of radiofrequency catheter ablation in 1500 consecutive patients with a wide variety of supraventricular and ventricular tachycardias treated in the Instituto Nacional de Cardiología "Ignacio Chavez", between April 22, 1992 until December of 1999. Tachycardias were associated with the presence of an accessory pathway in 987 patients (65.8%). Dual accessory pathways were present in 24 patients giving a total of 1,012 accessory pathways. The mechanism of the arrhythmia was atrioventricular nodal reentrant tachycardia in 321 patients (21.4%). Ablation of the reentrant circuit of atrial flutter within the right atrium was attempted in 109 (7.2%) patients and a primary atrial tachycardia in 13 patients (0.8%). Atrioventricular node ablation and permanent pacemaker implantation were performed in 26 patients (1.7%). Finally we performed radiofrequency catheter ablation in 37 (2.4%) patients with ventricular tachycardia. Radiofrequency catheter ablation was successful in 908 of 1012 (89.7%) patients with accessory pathways with a complication rate of 10 (0.98%) and a recurrence rate of 92 (9%). AV nodal reentry was successfully abolished in 319 of 321 patients by selective ablation of the slow pathway in 297/321 (92.5%) patients and the fast pathway in 22/24 (92%) patients. The complication rate of this group was 8/321 (2.4%) with a recurrence rate of 34 patients (10.5%). The reentrant circuit of atrial flutter was ablated successfully in 86 of 109 (76.8%) patients with a recurrence flutter in 14 (12.8%) patients. Five of 13 (38.4%) cases of primary atrial tachycardia were successfully ablated. Complete AV block was achieved in 26 of 26 (100%) patients with atrial fibrillation or flutter treated by AV nodal ablation. The procedure was successful in 28 of 37 (75.6%) patients with fascicular ventricular tachycardia. The results of this series of patients demonstrates the safety and efficacy of radiofrequency ablation for the treatment of a wide variety of taquicardias with high rate of success 1375 of 1500 patients (91.6%), with 142 recurrences (9.4%), 15 complications (1%), and no mortality.
多项报告表明，射频导管消融术能有效控制多种室上性和室性心动过速。本报告详细介绍了1992年4月22日至1999年12月期间，在墨西哥国立心脏病学研究所“伊格纳西奥·查韦斯”对1500例患有各种室上性和室性心动过速的连续患者进行射频导管消融的结果。987例患者（65.8%）的心动过速与存在旁路有关。24例患者存在双旁路，共计1012条旁路。心律失常的机制为房室结折返性心动过速的有321例患者（21.4%）。109例（7.2%）患者尝试消融右心房内的心房扑动折返环，13例（0.8%）患者为原发性房性心动过速。26例患者（1.7%）进行了房室结消融和永久性起搏器植入。最后，我们对37例（2.4%）室性心动过速患者进行了射频导管消融。1012例有旁路的患者中，908例（89.7%）射频导管消融成功，并发症发生率为10例（0.98%），复发率为92例（9%）。321例患者中，297/321（92.5%）例患者通过选择性消融慢径路、22/24（92%）例患者通过消融快径路，成功消除了房室结折返，该组并发症发生率为8/321（2.4%），复发率为34例（10.5%）。109例心房扑动患者中，86例（76.8%）成功消融了折返环，14例（12.8%）患者复发心房扑动。13例原发性房性心动过速患者中有5例（38.4%）成功消融。26例接受房室结消融治疗的心房颤动或心房扑动患者中，26例（100%）均实现了完全性房室传导阻滞。37例分支性室性心动过速患者中，28例（75.6%）手术成功。这一系列患者的结果表明，射频消融治疗各种心动过速具有安全性和有效性成功率高，1500例患者中有1375例（91.6%）成功，142例复发（9.4%），15例并发症（1%），无死亡病例。
