Chen S A, Tsang W P, Hsia C P, Wang D C, Chiang C E, Yeh H I, Chen J W, Ting C T, Chiou C W, Kong C W
Department of Medicine, National Yang-Ming Medical College, Taipei, Taiwan, ROC.
Int J Cardiol. 1992 Nov;37(2):199-207. doi: 10.1016/0167-5273(92)90209-l.
One hundred and twenty-five patients with accessory pathways mediated tachyarrhythmias underwent radiofrequency ablation. Right-sided accessory pathways were ablated from the atrial aspect of the tricuspid anulus (all from the femoral vein approach) and the left-sided accessory pathways were ablated from the atrial or ventricular aspect of the mitral anulus. Immediately after the procedures, 3 of 8 accessory pathways (38%) and 131 of 137 accessory pathways (95%) were ablated successfully with radiofrequency through a small-tip (2 mm) and a large-tip (4 mm) electrode catheter, respectively. Seven of the 11 accessory pathways that failed radiofrequency ablation had a later successful direct current ablation. During follow-up (3 to 22 months), serial electrophysiological study showed that 11 of the 114 patients (10%) with successful ablation had return of accessory pathway conduction (2 had recurrence of tachycardia, 2%). Complications included accidental AV block (1 patient), cardiac tamponade (1 patient) and possible aortic dissection (1 patient). Transient proarrhythmic effects (more atrial and ventricular premature beats) were seen during the first week and sustained ventricular tachyarrhythmias were not inducible. In a successful session, procedure and radiation exposure times (including the time for diagnostic procedures) were 3.8 +/- 0.2 h and 45 +/- 4 min, respectively. This study confirms that radiofrequency ablation with a large-tip electrode catheter is an effective and relatively safe nonsurgical method for treatment of Wolff-Parkinson-White syndrome, with a low complication and recurrence rate.
125例经旁路介导的快速心律失常患者接受了射频消融治疗。右侧旁路从三尖瓣环的心房侧进行消融（均经股静脉途径），左侧旁路从二尖瓣环的心房侧或心室侧进行消融。术后即刻，分别通过小尖端（2mm）和大尖端（4mm）电极导管成功消融了8条旁路中的3条（38%）和137条旁路中的131条（95%）。11条射频消融失败的旁路中有7条后来成功进行了直流电消融。随访期间（3至22个月），系列电生理研究显示，114例消融成功的患者中有11例（10%）出现旁路传导恢复（2例心动过速复发，2%）。并发症包括意外房室传导阻滞（1例患者）、心脏压塞（1例患者）和可能的主动脉夹层（1例患者）。在第一周观察到短暂的促心律失常效应（更多房性和室性早搏），未诱发持续性室性快速心律失常。在一次成功的手术中，手术和辐射暴露时间（包括诊断性手术时间）分别为3.8±0.2小时和45±4分钟。本研究证实，使用大尖端电极导管进行射频消融是治疗预激综合征的一种有效且相对安全的非手术方法，并发症和复发率较低。
