Lapage Martin J, Walsh Michael J, Reed John H, Saul J Philip
Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan.
Pacing Clin Electrophysiol. 2014 May;37(5):610-5. doi: 10.1111/pace.12324. Epub 2013 Dec 20.
This study describes the use of adenosine during ablation procedures to allow conduction through adenosine-dependent accessory pathways (APs), which are inactive at the time of the procedure. The technique allows for successful mapping and ablation of these pathways.
Retrospective review of all patients undergoing AP ablation from 1998 to 2008 to identify patients with absent or intermittent AP conduction during electrophysiology study. Adenosine boluses were used to activate the AP for the purpose of mapping in each case.
Adenosine mapping was utilized in seven patients. One patient had a concealed AP at baseline and six patients had manifest preexcitation at baseline but lost AP conduction during the case. Alternative methods of enhancing AP conduction were attempted in five patients, but failed. Acute ablation results included: four patients with complete elimination of AP conduction, two patients with AP conduction only with adenosine, and one patient with return of baseline preexcitation. Patients with residual antegrade conduction had right superior (anterior) septal APs considered too close to the atrioventricular conduction system for safe ablation. At median follow-up of 2 years, all three patients with residual AP conduction had recurrence of supraventricular tachycardia; the remainder remained free of preexcitation and SVT.
Adenosine mapping is a useful technique for facilitating AP ablation when pathway conduction is absent or inconsistent, and may enhance conduction in mechanically inhibited or previously ablated APs. Recurrence of AP conduction only during adenosine administration is predictive of late recurrence.
本研究描述了在消融手术过程中使用腺苷，以使电流通过腺苷依赖性旁路（APs），这些旁路在手术时处于无活性状态。该技术有助于成功标测和消融这些旁路。
回顾性分析1998年至2008年期间所有接受AP消融的患者，以确定在电生理研究中AP传导缺失或间歇性传导的患者。在每种情况下，均使用腺苷推注来激活AP以进行标测。
七名患者使用了腺苷标测。一名患者基线时存在隐匿性AP，六名患者基线时存在显性预激，但术中失去了AP传导。五名患者尝试了增强AP传导的其他方法，但均失败。急性消融结果包括：四名患者的AP传导完全消除，两名患者仅在使用腺苷时存在AP传导，一名患者恢复至基线预激状态。残留前向传导的患者有右上（前）间隔AP，因距离房室传导系统过近而无法安全消融。中位随访2年时，所有三名残留AP传导的患者均出现室上性心动过速复发；其余患者无预激和室上性心动过速。
当旁路传导缺失或不一致时，腺苷标测是促进AP消融的有用技术，并且可能增强机械性抑制或先前消融的AP中的传导。仅在腺苷给药期间出现AP传导复发可预测晚期复发。
