Schlüter M, Kuck K H
Department of Cardiology, University Hospital Eppendorf, Hamburg, Germany.
J Am Coll Cardiol. 1992 Mar 1;19(3):663-70. doi: 10.1016/s0735-1097(10)80289-x.
Catheter ablation with radiofrequency current has recently been introduced as a therapeutic regimen for symptomatic patients with the Wolff-Parkinson-White syndrome or atrioventricular (AV) tachycardia mediated by a retrogradely conducting (concealed) accessory AV pathway. These pathways may be located, although infrequently, in the anteroseptal region of the heart in close proximity to the AV node-His bundle conduction system. Any attempt to interrupt an anteroseptal accessory pathway therefore is subject to the potential complication of inadvertent impairment of normal AV conduction. This study was conducted to establish whether abolition of anteroseptal accessory pathways by radiofrequency current aimed at the atrial as opposed to the ventricular insertion of the pathway can be achieved with preservation of AV node-His bundle conduction. Twelve patients (mean age 37 +/- 13 years; 10 with Wolff-Parkinson-White syndrome, 2 with a concealed accessory pathway) were studied. In the majority of patients, radiofrequency current (500 kHz; mean energy 577 +/- 207 J) was applied through a steerable catheter with a long tip electrode placed in the anterior septal space at the atrial aspect of the tricuspid anulus, with the intention to destroy the atrial insertion of the accessory pathway. All pathways were successfully ablated. The AV node or His bundle conduction was not impaired in any patient. Right bundle branch block was induced in two patients (17%). There were no complications related to the procedure. It is concluded that catheter ablation from the right atrium using radiofrequency current provides effective and safe interruption of anteroseptal accessory pathways with good preservation of the normal conduction system.
最近，射频电流导管消融术已被引入作为治疗有症状的预激综合征或由逆向传导（隐匿性）房室旁道介导的房室（AV）心动过速患者的一种治疗方案。这些旁道虽然不常见，但可能位于心脏的前间隔区域，紧邻房室结-希氏束传导系统。因此，任何试图阻断前间隔旁道的操作都有可能意外损害正常房室传导。本研究旨在确定通过将射频电流作用于旁道的心房端而非心室端来消除前间隔旁道，同时保留房室结-希氏束传导是否可行。研究了12例患者（平均年龄37±13岁；10例预激综合征患者，2例隐匿性旁道患者）。在大多数患者中，通过一根可操纵导管施加射频电流（500kHz；平均能量577±207J），导管的长尖端电极置于三尖瓣环心房侧的前间隔空间，目的是破坏旁道的心房端。所有旁道均成功消融。所有患者的房室结或希氏束传导均未受损。2例患者（17%）诱发了右束支传导阻滞。未发生与手术相关的并发症。结论是，使用射频电流从右心房进行导管消融可有效、安全地阻断前间隔旁道，同时很好地保留正常传导系统。
