Sneddon J F, Ward D E, Simpson I A, Linker N J, Wainwright R J, Camm A J
Department of Cardiological Sciences, St George's Hospital Medical School, London.
Br Heart J. 1991 Mar;65(3):143-7. doi: 10.1136/hrt.65.3.143.
Transcoronary ablation of atrioventricular conduction by dehydrated alcohol was attempted in 14 patients with refractory atrial arrhythmias. Alcohol (0.5 or 1.0 ml) was delivered after selective catheterisation of the atrioventricular nodal artery in the 10 patients in whom the artery could be identified by cineangiography. The other four patients underwent electrical ablation when the nodal artery could not be catheterised. Temporary atrioventricular block induced by dilute contrast and cold saline (0.9%) confirmed that the catheter was in the correct position before the alcohol was delivered. In all 10 patients complete atrioventricular block developed after alcohol ablation. The block persisted in all four patients given 1.0 ml alcohol but not in four of the six given 0.5 ml. The mean (SD) creatine kinase (MB fraction) at four to six hours after ablation was 76.5 (49.5) IU after 1.0 ml and 75.5 (43.1) IU after 0.5 ml alcohol (normal less than 20 IU). The overall success rate of alcohol ablation in the whole group on an "intention to treat" basis was 43%. The procedure was a technical success in six of the 10 patients in whom the nodal artery was identified. Transcoronary alcohol ablation of atrioventricular conduction should be considered in patients in whom electrical techniques have been unsuccessful.
对14例难治性房性心律失常患者尝试了经冠状动脉无水乙醇消融房室传导。在10例通过电影血管造影能识别房室结动脉的患者中，经选择性导管插入该动脉后注入无水乙醇（0.5或1.0 ml）。另外4例在无法对结动脉进行导管插入时接受了电消融。在注入无水乙醇前，用稀释造影剂和冷生理盐水（0.9%）诱发的暂时性房室传导阻滞证实导管位置正确。在所有10例患者中，无水乙醇消融后均发生了完全性房室传导阻滞。接受1.0 ml无水乙醇的4例患者中阻滞持续存在，但接受0.5 ml无水乙醇的6例患者中有4例阻滞未持续。消融后4至6小时，接受1.0 ml无水乙醇者肌酸激酶（MB同工酶）的平均（标准差）值为76.5（49.5）IU，接受0.5 ml无水乙醇者为75.5（43.1）IU（正常小于20 IU）。基于“意向性治疗”，整个组无水乙醇消融的总体成功率为43%。在10例识别出结动脉的患者中，有6例手术取得技术成功。对于电技术治疗失败的患者，应考虑经冠状动脉无水乙醇消融房室传导。
