Yamagata Kenichiro, Wichterle Dan, Peichl Petr, Aldhoon Bashar, Čihák Robert, Kautzner Josef
Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Vídeňská 1958/9, Prague, 140 21, Czech Republic.
BMC Cardiovasc Disord. 2015 Oct 28;15:139. doi: 10.1186/s12872-015-0132-z.
Mitral isthmus is often targeted as a part of stepwise approach during radiofrequency ablation for persistent atrial ablation. Acute success rate in achieving the mitral isthmus block is only modest, late reconduction rate is relatively high and, consequently, incomplete lesion may be proarrhythmic. We describe the first-in-man experience with successful MI ablation by bipolar RF energy delivery.
A 64-year-old caucasian man after two previous ablation procedures for drug resistant atrial fibrillation in recent four years, which included pulmonary vein isolation and linear left atrial lesions, was referred for the treatment of recurrent perimitral flutter. Despite the third attempt to create bidirectional block at the mitral isthmus region, we were not even able to stop the arrhythmia by aggressive unipolar radiofrequency ablation both from the left atrium and coronary sinus, because of deeply embedded slow conducting channel probably around the vein of Marshall. Arrhythmia was finally terminated and the block was achieved by bipolar radiofrequency ablation between two irrigated-tip catheters positioned at the left atrial endocardium and contralaterally inside the coronary sinus.
Bipolar radiofrequency energy delivery can be an option for ablation of perimitral flutter resistant to standard unipolar radiofrequency ablation. This may improve clinical outcome of patients undergoing non-pharmacological treatment for persistent atrial fibrillation. The safety and efficacy of this technique has to be confirmed in future studies.
在持续性心房颤动的射频消融治疗中，二尖瓣峡部常作为逐步消融策略的一部分被作为靶点。实现二尖瓣峡部阻滞的急性成功率仅为中等水平，晚期再传导率相对较高，因此，不完全损伤可能具有促心律失常作用。我们描述了首例通过双极射频能量传递成功消融二尖瓣峡部的人体经验。
一名64岁的白种男性，在过去四年中因药物难治性心房颤动接受了两次消融手术，包括肺静脉隔离和左心房线性消融，此次因复发性二尖瓣周围性心动过速前来就诊。尽管第三次尝试在二尖瓣峡部区域创建双向阻滞，但由于可能在Marshall静脉周围存在深深嵌入的缓慢传导通道，我们甚至无法通过从左心房和冠状窦进行积极的单极射频消融来终止心律失常。最终，通过将两根灌注尖端导管分别置于左心房内膜和对侧冠状窦内进行双极射频消融，心律失常得以终止，阻滞得以实现。
对于标准单极射频消融难治的二尖瓣周围性心动过速，双极射频能量传递可作为一种消融选择。这可能改善接受持续性心房颤动非药物治疗患者的临床结局。该技术的安全性和有效性有待未来研究证实。
