Vega-Arrillaga F, Young M L, Wu J M, Wolff G S
Department of Pediatrics, University of Miami, Miami, Florida, USA.
Pacing Clin Electrophysiol. 2000 Dec;23(12):2097-100. doi: 10.1111/j.1540-8159.2000.tb00782.x.
Previous studies have shown that with low temperature testing for RF ablation of arrhythmias, unnecessary irreversible myocardial lesions may be avoided. In children admitted for RF ablation from June 1996 to May 1999, we evaluated the method of an initial temperature setting of 50 degrees C for a maximum of 10 seconds. If accessory pathway block occurred, the temperature setting was immediately increased to 70 degrees C and continued for 45-120 seconds (group 1). If accessory pathway block did not occur after several attempts, subsequent attempts were made with initial settings at 70 degrees C-80 degrees C at the same or different sites (group 2). Eighty patients with Wolff-Parkinson-White syndrome (mean age 11 +/- 4 years) were treated using this method. Twelve patients were excluded for various reasons. Of the remaining 68 patients, 52 (76%) had successful block of the pathway at 50 degrees C; 16 patients demonstrated block only at the higher temperature setting of 70 degrees C-80 degrees C. There were no statistically significant differences between these two groups in terms of age, weight, and location of accessory pathways. Unsuccessful 50 degrees C test ablation attempts were 1.6 +/- 2.4 in group 1 and 3.1 +/- 2.9 in group 2 (P = 0.04). Total unsuccessful attempts were 1.6 +/- 2.4 in group 1 and 8.1 +/- 7.1 in group 2 (P = 0.001). The time from application of RF energy to the time of AP block in group 1 was not significantly different from group 2. In the majority of children, successful RF ablation can be achieved by using a temperature setting of 50 degrees C, then 70 degrees C. This will prevent unnecessary permanent injury at unsuccessful attempt sites.
先前的研究表明，在心律失常的射频消融低温测试中，可以避免不必要的不可逆心肌损伤。在1996年6月至1999年5月因射频消融入院的儿童中，我们评估了初始温度设置为50摄氏度、最长持续10秒的方法。如果出现旁路阻滞，温度设置立即提高到70摄氏度并持续45 - 120秒（第1组）。如果经过几次尝试后未出现旁路阻滞，则在相同或不同部位以70摄氏度 - 80摄氏度的初始设置进行后续尝试（第2组）。使用该方法治疗了80例 Wolff - Parkinson - White 综合征患者（平均年龄11±4岁）。12例患者因各种原因被排除。在其余68例患者中，52例（76%）在50摄氏度时成功实现了通路阻滞；16例患者仅在70摄氏度 - 80摄氏度的较高温度设置下出现阻滞。这两组在年龄、体重和旁路位置方面无统计学显著差异。第1组50摄氏度测试消融未成功的尝试次数为1.6±2.4次，第2组为3.1±2.9次（P = 0.04）。第1组总的未成功尝试次数为1.6±2.4次，第2组为8.1±7.1次（P = 0.001）。第1组从施加射频能量到出现房室旁路阻滞的时间与第2组无显著差异。在大多数儿童中，通过先设置50摄氏度然后70摄氏度的温度，可以实现成功的射频消融。这将避免在未成功尝试部位造成不必要的永久性损伤。
