Iyer R, Hameed S, Vora A M, Lokhandwala Y
Department of Cardiology, KEM Hospital, Mumbai.
J Indian Med Assoc. 2000 Nov;98(11):684-7, 690.
Radiofrequency (RF) ablation is a new modality of pennanently curing patients with various tachycardias using radiofrequency energy, a technique evolved in the past decade. RF ablation was performed on 913 patients with different tachyarrhythmias from April, 1994 to July, 1999. There were 491 men and 422 females aged 42 +/- 34 years (range 1 to 76 years). Supraventricular tachycardia (SVT) was present in 462 patients, accessory pathway mediated atrioventricular re-entrant tachycardia (AVRT) in 355 patients (377 accessory pathways) and idiopathic ventricular tachycardia (VT) in 96 patients. Amongst the patients with SVT, 402 had atrioventricular nodal re-entrant tachycardia (AVNRT), 22 had atrial flutter, 20 had ectopic atrial tachycardia and 18 had atrial fibrillation. RF successfully abolished the tachycardia in 400/402 patients (99.5%) with AVNRT, 330/377 (87.5%) accessory pathways in patients with AVRT, 14/22 patients (63.6%) of atrial flutter, 18/20 patients (90%) of atrial tachycardia and 79/96 patients (82.3%) with idiopathicVT. Successful AV nodal ablation with pacemaker implantation was done in 10/18 patients with chronic atrial fibrillation with fast ventricular rate and tachycardia induced cardiomyopathy. AV nodal modulation for atrial fibrillation was tried in the remaining 8 patients and was successful in 4 (4/8). The overall success rate for all arrhythmias was 93.6%, and there was no mortality. At a follow-up of 6.8 +/- 5.4 months, there was a recurrence in 34/420 patients (8%), in whom successful re-ablation was performed. One patient with AVNRT and another with a parahisian pathway developed complete heart block and were given pacemakers. One patient developed inferior wall infarction on the next day post RF. There were 4 patients who had pericardial tamponade necessitating pericardiocentesis and 2 patients developed deep vein thrombosis, which was treated conservatively. Thus RF ablation is an effective, safe and curative therapy for various arrhythmias.
射频消融是利用射频能量永久性治愈各类心动过速患者的一种新方法，是过去十年间发展起来的一项技术。1994年4月至1999年7月，对913例患有不同心律失常的患者进行了射频消融。其中男性491例，女性422例，年龄42±34岁（范围1至76岁）。462例患者为室上性心动过速（SVT），355例患者为旁路介导的房室折返性心动过速（AVRT）（377条旁路），96例患者为特发性室性心动过速（VT）。在SVT患者中，402例为房室结折返性心动过速（AVNRT），22例为心房扑动，20例为异位房性心动过速，18例为心房颤动。射频成功消除了400/402例（99.5%）AVNRT患者的心动过速，330/377例（87.5%）AVRT患者的旁路，14/22例（63.6%）心房扑动患者的心动过速，18/20例（90%）房性心动过速患者的心动过速，以及79/96例（82.3%）特发性VT患者的心动过速。对10/18例慢性心房颤动伴快速心室率和心动过速性心肌病患者成功进行了房室结消融并植入起搏器。对其余8例患者尝试进行心房颤动的房室结改良，4例（4/8）成功。所有心律失常的总体成功率为93.6%，无死亡病例。在6.8±5.4个月的随访中，420例患者中有34例（8%）复发，对这些患者成功进行了再次消融。1例AVNRT患者和1例希氏束旁旁路患者发生完全性心脏传导阻滞并植入了起搏器。1例患者在射频消融术后第二天发生下壁梗死。有4例患者发生心包填塞，需要进行心包穿刺，2例患者发生深静脉血栓形成，采用保守治疗。因此，射频消融是治疗各种心律失常的一种有效、安全且可治愈的疗法。
