Warren R J, Vohra J K, Chan W, Lichtenstein M, Mond H G, Hunt D
Royal Melbourne Hospital, Vic., Australia.
Aust N Z J Med. 1991 Feb;21(1):25-8. doi: 10.1111/j.1445-5994.1991.tb02997.x.
Catheter-induced His bundle ablation for refractory supraventricular arrhythmias is most commonly performed with direct-current shock energy of 200-300 joules. The high energy pulse delivered by direct-current shock produces a lesion in the atrioventricular node by fulguration, with the residual energy being dissipated as a pressure wave. The effect of direct-current shock His bundle ablation on global and regional ventricular function was assessed in 14 consecutive patients by radionuclide ventriculography performed before and after ablation and again three months later. All studies were performed with ventricular pacing at 110 bpm. Global left ventricular ejection fraction was found to be significantly reduced at the three month study (0.43 +/- 0.03 vs 0.50 +/- 0.03, pre ablation, p = 0.02). A significant reduction in wall-motion score was also seen in six of the seven patients who had normal wall motion in pacing rhythm prior to ablation. Deterioration was mainly seen at the left and right ventricular apices. The observed reduction in ventricular function that follows direct-current shock His bundle ablation may result from myocardial damage from electro-coagulation or from barotrauma and supports continued investigation into alternative, less traumatic energy sources for the procedure.
导管诱导的希氏束消融治疗难治性室上性心律失常最常采用200 - 300焦耳的直流电冲击能量。直流电冲击传递的高能量脉冲通过电灼在房室结产生损伤，残余能量以压力波形式消散。通过在消融前后及三个月后进行放射性核素心室造影，对14例连续患者评估直流电冲击希氏束消融对整体和局部心室功能的影响。所有研究均在心室率110次/分钟的心室起搏下进行。在三个月的研究中发现整体左心室射血分数显著降低（消融前为0.50±0.03，三个月时为0.43±0.03，p = 0.02）。在消融前起搏心律时室壁运动正常的7例患者中，有6例室壁运动评分也显著降低。恶化主要见于左、右心室心尖部。直流电冲击希氏束消融后观察到的心室功能降低可能是由于电凝导致的心肌损伤或气压伤所致，这支持继续研究该手术的替代、创伤较小的能量来源。
