Warin J F, Haissaguerre M, Le Métayer P, Montserrat P, Massière J P
Service de Cardiologie, Hôpital Saint-André, Bordeaux.
Ann Cardiol Angeiol (Paris). 1989 Sep 15;38(7):385-8.
Ablation of accessory pathway (AP) of any location was performed either with a right or a left approach (patent foramen ovale, transpeptal or a retrograde transvalvular aortic catheterism in 121 patients. The best ablation site was localized: 1) by the recording of a potential likely with the Kent bundle activation; 2) the earliest site of retrograde atrial activation during orthodromic reciprocating tachycardia (80 +/- 35 ms); 3) first ventricular potentials recorded ahead or synchronous with the delta wave in standard leads; 4) disappearance of preexcitation due to the pressure of the catheter on the AP (8 patients); 5) good degree of pace-map concordance with the major preexcitation. Two 160 joules cathodic shocks in close succession induced the disappearance of preexcitation in 113 patients. No recurrence of arrhythmia occurred in 118 patients without any preventive treatment with a follow-up ranging from 2 to 49 months (10 +/- 8). No serious side effect were observed except three permanent complete AV block. However one of them occurred after an unsuccessful surgical attempt which obviously had damaged the AV junction. Fulguration is efficient in any location of AP and can be the first line treatment in patients at risk with the WPW either symptomatic or not. These results indicate that appropriate treatment of patient the Wolff-Parkinson-White syndrome could be reassessed.
对任何部位的附加旁路（AP）进行消融时，采用右侧或左侧入路（经卵圆孔未闭、经房间隔或逆行经瓣膜主动脉导管插入术，共121例患者）。最佳消融部位通过以下方法确定：1）记录可能与肯特束激动相关的电位；2）在顺向折返性心动过速期间逆行心房激动的最早部位（80±35毫秒）；3）在标准导联中先于或与δ波同步记录到的最早心室电位；4）由于导管对AP的压迫导致预激消失（8例患者）；5）起搏标测与主要预激的良好一致性。连续两次160焦耳的阴极电击使113例患者的预激消失。118例未接受任何预防性治疗的患者，随访2至49个月（10±8），未发生心律失常复发。除3例永久性完全性房室传导阻滞外，未观察到严重副作用。然而，其中1例发生在手术尝试失败后，显然已损伤房室交界区。电灼在AP的任何部位都有效，对于有症状或无症状的WPW综合征高危患者可作为一线治疗。这些结果表明，对 Wolff-Parkinson-White综合征患者的适当治疗可能需要重新评估。
