Lee M E
Centinela Hospital Medical Center, Inglewood, CA 90307.
Mt Sinai J Med. 1992 Sep;59(4):357-61.
Surgical cure of right atrial arrhythmias may be accomplished by excision, exclusion, or cryoablation of the arrhythmogenic focus. Cryoablation may be performed epicardially without cardiopulmonary bypass but carries an operative recurrence rate of 57%. Successful cryoablation of a right atrial arrhythmia requires the reliable creation of transmural tissue necrosis. Heat transferred to the endocardium from normothermic circulating blood in the atrium or within the atrial wall may prevent full-thickness, lethal freezes. This study demonstrates that compression of myocardial tissue between an external cryoprobe and an endocardial template produces endocardial thermal isolation of the target area by displacing warm solutions from the endocardium. This is essential to achieve consistently lethal transmural freezes of -60 degrees C. Use of this technique may reduce the high operative recurrence rate of right atrial tachycardias treated with conventional cryoablation techniques.
右房心律失常的手术治疗可通过切除、隔离或冷冻消融致心律失常病灶来实现。冷冻消融可在非体外循环下经心外膜进行，但手术复发率为57%。成功的右房心律失常冷冻消融需要可靠地造成透壁组织坏死。心房内或心房壁内常温循环血液传递至心内膜的热量可能会阻止全层致死性冷冻。本研究表明，外部冷冻探头与心内膜模板之间对心肌组织的压迫通过驱离心内膜的温溶液而产生目标区域的心内膜热隔离。这对于持续实现-60℃的致死性透壁冷冻至关重要。使用该技术可能会降低传统冷冻消融技术治疗右房性心动过速的高手术复发率。
