Sousa J, el-Atassi R, Rosenheck S, Calkins H, Langberg J, Morady F
Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109-0022.
Circulation. 1991 Aug;84(2):567-71. doi: 10.1161/01.cir.84.2.567.
The purpose of this study was to describe a new technique for catheter ablation of the atrioventricular junction using radiofrequency energy delivered in the left ventricle.
Catheter ablation of the atrioventricular (AV) junction using a catheter positioned across the tricuspid annulus was unsuccessful in eight patients with a mean +/- SD age of 51 +/- 19 years who had AV nodal reentry tachycardia (three patients), orthodromic tachycardia using a concealed midseptal accessory pathway, atrial tachycardia, atrial flutter (two patients), or atrial fibrillation. Before attempts at catheter ablation of the AV junction, each patient had been refractory to pharmacological therapy, and four had failed attempts at either catheter modification of the AV node using radiofrequency energy or surgical and catheter ablation of the accessory pathway. Conventional right-sided catheter ablation of the AV junction using radiofrequency energy in six patients and both radiofrequency energy and direct current shocks in two patients was ineffective. The mean amplitude of the His bundle potential recorded at the tricuspid annulus at the sites of unsuccessful AV junction ablation was 0.1 +/- 0.08 mV, with a maximum His amplitude of 0.03-0.28 mV. A 7F deflectable-tip quadripolar electrode catheter with a 4-mm distal electrode was positioned against the upper left ventricular septum using a retrograde aortic approach from the femoral artery. Third-degree AV block was induced in each of the eight patients with 20-36 W applied for 15-30 seconds. The His bundle potential at the sites of successful AV junction ablation ranged from 0.06 to 0.99 mV, with a mean of 0.27 +/- 0.32 mV. There was no rise in the creatine kinase-MB fraction and no complications occurred. An intrinsic escape rhythm of 30-60 beats/min was present in seven of the eight patients. Each patient received a permanent pacemaker and has been asymptomatic during 3-13 months of follow-up.
Catheter ablation of the AV junction can be achieved effectively and safely using radiofrequency energy delivered in the left ventricle when the conventional right-sided approach is unsuccessful.
本研究的目的是描述一种利用经左心室输送的射频能量进行房室结导管消融的新技术。
8例患者（平均年龄51±19岁），其中3例为房室结折返性心动过速，3例为使用隐匿性中隔旁道的顺向性心动过速，1例为房性心动过速，2例为心房扑动，1例为心房颤动，采用经三尖瓣环放置导管进行房室结导管消融未成功。在尝试进行房室结导管消融之前，每位患者对药物治疗均无效，4例患者曾尝试使用射频能量对房室结进行导管改良或对旁道进行手术及导管消融但均失败。6例患者采用传统的经右侧射频能量进行房室结导管消融，2例患者同时采用射频能量和直流电电击均无效。在房室结消融失败部位的三尖瓣环处记录到的希氏束电位平均幅度为0.1±0.08mV，最大希氏束电位幅度为0.03 - 0.28mV。使用一根带有4mm远端电极的7F可弯 tip 四极电极导管，经股动脉逆行主动脉途径将其置于左心室上部间隔处。8例患者中，每例均施加20 - 36W能量持续15 - 30秒，均诱发了三度房室传导阻滞。成功进行房室结消融部位的希氏束电位范围为0.06至0.99mV，平均为0.27±0.32mV。肌酸激酶 - MB同工酶水平未升高，且未发生并发症。8例患者中有7例出现30 - 60次/分钟的固有逸搏心律。每位患者均接受了永久性起搏器植入，在3 - 13个月的随访期间均无症状。
当传统的经右侧途径不成功时，利用经左心室输送的射频能量可有效且安全地实现房室结导管消融。
