Shen E N
John A Burns School of Medicine, University of Hawaii.
Hawaii Med J. 1992 Feb;51(2):39-43.
Other than atrial fibrillation-flutter, the majority of supraventricular tachyarrhythmias involve either a macro-re-entry circuit utilizing an atrioventricular (AV) accessory pathway or a micro-re-entry circuit inside or around the AV node. The traditional form of therapy has been medical, with suppression by antiarrhythmic agents, most of which carry a heavy side-effect profile. The established alternative for medical therapy has been surgery, with open-chest excisional ablation of the accessory pathway or cryo-modification of the AV node. Even though, as opposed to medical therapy, surgery promises cure, it requires thoracotomy and cardiopulmonary bypass with significant associated morbidity and even mortality, as well as high cost. Ten years ago, the technique of "fulguration" was first introduced, which involved the delivery of an electrical charge through specialized catheters. Our first experience with this technique was reported in this Journal. Unfortunately, despite being a much better tolerated curative procedure involving a very brief hospitalization, the use of high-energy direct current (DC) shocks is associated with a low but significant incidence of serious complications including cardiac perforation, hypotension, coronary artery spasm, and late occurrence of ventricular fibrillation. Concerns about these potential complications have markedly limited the application of the catheter technique. In the past 2 years, adoption of radio-frequency (RF) current as the energy source has allowed the ablation to be performed in a very efficacious and much safer fashion. We would like to report the first experience with this technique in Hawaii.
除心房颤动-扑动外，大多数室上性快速心律失常涉及利用房室（AV）旁道的大折返环路或房室结内部或周围的微折返环路。传统的治疗方式是药物治疗，使用抗心律失常药物进行抑制，但大多数这类药物都有严重的副作用。已确立的药物治疗替代方法是手术，即通过开胸切除旁道或对房室结进行冷冻改良。尽管与药物治疗不同，手术有望治愈疾病，但它需要开胸和体外循环，会带来显著的相关发病率甚至死亡率，而且成本高昂。十年前，首次引入了“电灼”技术，该技术涉及通过专用导管输送电荷。我们对这项技术的首次经验在本期刊上有所报道。不幸的是，尽管这是一种耐受性更好的治愈性手术，住院时间很短，但使用高能直流电（DC）电击会伴有低但显著的严重并发症发生率，包括心脏穿孔、低血压、冠状动脉痉挛以及晚期室颤的发生。对这些潜在并发症的担忧显著限制了导管技术的应用。在过去两年中，采用射频（RF）电流作为能量源使得消融能够以非常有效且安全得多的方式进行。我们想报告在夏威夷使用这项技术的首次经验。
