Issa Ziad F, Amr Bashar S, Laham Hytham
Southern Illinois University, Department of Medicine, Springfield, Illinois; Prairie Cardiovascular Consultants, Springfield, Illinois.
Pacing Clin Electrophysiol. 2015 Feb;38(2):254-8. doi: 10.1111/pace.12525. Epub 2014 Oct 15.
Ablation of the atrioventricular junction (AVJ) combined with pacemaker implantation (the "ablate and pace" approach) has been an effective treatment strategy for patients with atrial fibrillation (AF) when rate control is the goal of therapy and when rapid ventricular rates during AF is refractory to pharmacologic therapy.
This report describes the feasibility and safety of catheter ablation of AVJ via a superior vena cava (SVC) approach performed during concurrent pacemaker or defibrillator implantation.
A total of 170 consecutive patients with drug-refractory AF underwent combined AVJ ablation and pacemaker or defibrillator implantation using the axillary or subclavian venous approach. The acute and long-term success of achieving complete atrioventricular (AV) block, the impact of the ablation procedure on the total procedure time and fluoroscopy duration, and procedural complications were evaluated.
A dual-chamber device in 61% of patients and biventricular device in 39% patients. Catheter ablation of the AVJ was acutely successful in 166 patients (97.6%). The mean procedure time of the AVJ ablation was 7.0 ± 3.3 minutes and the mean fluoroscopy time during the ablation procedure was 3.1 ± 3.2 minutes. The average duration of RF energy application required to achieve complete AV block was 129 ± 65 seconds. Procedural complications were observed in seven patients. Complete AV block persisted in 96% of patients during a mean follow-up of 26 ± 16 months.
Catheter ablation of the AVJ can be performed successfully and safely using the SVC approach in patients undergoing concurrent device implantation, and it may offer several advantages over the conventional femoral approach.
当治疗目标是控制心率且房颤（AF）时快速心室率对药物治疗无效时，房室结（AVJ）消融联合起搏器植入（“消融并起搏”方法）一直是房颤患者的有效治疗策略。
本报告描述了在同时植入起搏器或除颤器期间，经上腔静脉（SVC）途径进行AVJ导管消融的可行性和安全性。
共有170例药物难治性房颤患者采用腋静脉或锁骨下静脉途径，接受了AVJ消融联合起搏器或除颤器植入。评估了实现完全房室（AV）阻滞的急性和长期成功率、消融过程对总手术时间和透视时间的影响以及手术并发症。
61%的患者植入双腔装置，39%的患者植入双心室装置。166例患者（97.6%）AVJ导管消融急性成功。AVJ消融的平均手术时间为7.0±3.3分钟，消融过程中的平均透视时间为3.1±3.2分钟。实现完全AV阻滞所需的射频能量平均应用持续时间为129±65秒。7例患者出现手术并发症。在平均26±16个月的随访期间，96%的患者持续存在完全AV阻滞。
在同时进行装置植入的患者中，使用SVC途径可以成功且安全地进行AVJ导管消融，与传统的股静脉途径相比，它可能具有几个优点。
