Yeo Wee Tiong, Sporton Simon C E, Dhinoja Mehul, Schilling Richard J, Earley Mark J
Department of Cardiology, St Bartholomew's Hospital, London, UK; Department of Cardiology, National University Heart Centre, Singapore.
Pacing Clin Electrophysiol. 2013 Nov;36(11):1357-63. doi: 10.1111/pace.12199. Epub 2013 Jun 13.
Atrioventricular node (AVN) ablation is effective for rate control in atrial fibrillation. This may require multiple radiofrequency applications to achieve complete atrioventricular block (CAB). In this retrospective study, we tested the hypothesis that mapping the AVN utilizing electrograms (EGMs) on both proximal and distal bipoles of the mapping catheter may improve the likelihood of CAB.
Lesion characteristics and EGM components on the proximal and distal bipoles of the ablation catheter in first-time AVN ablation procedures were analyzed. Outcomes of each lesion, including presence of CAB, acute recurrence of AVN conduction, new-onset right bundle branch block (RBBB), and junctional escape rhythm, were analyzed. Multivariate binary logistic regression analysis was performed to identify EGM characteristics that independently predicted the outcomes of interest. Lesions with these EGM characteristics were then identified and their outcomes compared with the whole cohort.
A total of 441 ablation lesions were analyzed. EGM characteristics that independently predicted outcomes were the presence of His and atrial EGMs on the distal bipole and the absence of ventricular EGM on the proximal bipole. Among the 25 lesions with all these characteristics, 18 (72%) resulted in CAB compared to the overall cohort rate of 38% (P = 0.001). There was no new-onset RBBB. The likelihood of acute recurrent AVN conduction and junctional escape rhythm were similar.
Combining proximal and distal bipole EGM characteristics of the ablation catheter can improve the accuracy of AVN localization during AVN ablation and avoid right bundle branch injury.
房室结（AVN）消融术对房颤的心率控制有效。这可能需要多次射频应用以实现完全房室传导阻滞（CAB）。在这项回顾性研究中，我们检验了这样一个假设，即利用标测导管近端和远端双极上的电图（EGM）对房室结进行标测可能会提高实现CAB的可能性。
分析首次房室结消融术中消融导管近端和远端双极上的病变特征和EGM成分。分析每个病变的结果，包括CAB的存在、房室结传导的急性复发、新发右束支传导阻滞（RBBB）和交界性逸搏心律。进行多变量二元逻辑回归分析以确定独立预测感兴趣结果的EGM特征。然后识别具有这些EGM特征的病变，并将其结果与整个队列进行比较。
共分析了441个消融病变。独立预测结果的EGM特征是远端双极上存在希氏束和心房EGM，以及近端双极上不存在心室EGM。在具有所有这些特征的25个病变中，18个（72%）导致了CAB，而整个队列的发生率为38%（P = 0.001）。没有新发RBBB。急性房室结传导复发和交界性逸搏心律的可能性相似。
结合消融导管近端和远端双极的EGM特征可以提高房室结消融术中房室结定位的准确性，并避免右束支损伤。
