犬类和人类右心室希氏束旁区域射频导管消融的实验、病理及临床研究结果
Experimental, Pathologic, and Clinical Findings of Radiofrequency Catheter Ablation of Para-Hisian Region From the Right Ventricle in Dogs and Humans.
作者信息
Xue Yumei, Zhan Xianzhang, Wu Shulin, Wang Hongyue, Liu Yang, Liao Zili, Deng Hai, Duan Xuejing, Zeng Shaoying, Liang Dongpo, Elvan Arif, Fang Xianhong, Liao Hongtao, Ramdat Misier Anand R, Smit Jaap Jan J, Metzner Andreas, Heeger Christian-Hendrik, Liu Fangzhou, Wang Feng, Zhang Zhiwei, Kuck Karl-Heinz, Yen Ho Siew, Ouyang Feifan
机构信息
From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A.E., A.R.R.M., J.J.J.S.); Asklepios Klinik St. Georg, Hamburg, Germany (A.M., C.-H.,H., K.-H.K., F.O.); and Department of Pediatrics, National Heart and Lung Institute, Royal Brompton Hospital, Imperial College School of Medicine, London, United Kingdom (S.Y.H.).
出版信息
Circ Arrhythm Electrophysiol. 2017 Jun;10(6). doi: 10.1161/CIRCEP.116.005207.
BACKGROUND
Ablation of para-Hisian accessory pathway (AP) poses high risks of atrioventricular block. We developed a pacing technique to differentiate the near-field (NF) from far-field His activations to avoid the complication.
METHODS AND RESULTS
Three-dimensional mapping of the right ventricle was performed in 15 mongrel dogs and 23 patients with para-Hisian AP. Using different pacing outputs, the NF- and far-field His activation was identified on the ventricular aspect. Radiofrequency application was delivered at the NF His site in 8 (group 1) and the far-field His site in 7 dogs (group 2), followed by pathologic examination after 14 days. NF His activation was captured with 5 mA/1 ms in 10 and 10 mA/1 ms in 5 dogs. In group 1, radiofrequency delivery resulted in complete atrioventricular block in 3, right bundle branch block with HV (His-to-ventricular) interval prolongation in 1, and only right bundle branch block in 2 dogs, whereas no changes occurred in group 2. Pathologic examination in group-1 dogs showed complete or partial necrosis of the His bundle in 4 and complete necrosis of the right bundle branch in 5 dogs. In group 2, partial necrosis in the right bundle branch was found only in 1 dog. Using this pacing technique, the APs were 5.7±1.2 mm away from the His bundle located superiorly in 20 or inferiorly in 3 patients. All APs were successfully eliminated with 1 to 3 radiofrequency applications. No complications and recurrence occurred during a follow-up of 11.8±1.4 months.
CONCLUSIONS
Differentiating the NF His from far-field His activations led to a high ablation success without atrioventricular block in para-Hisian AP patients.
背景
希氏束旁旁路（AP）消融术具有较高的房室传导阻滞风险。我们开发了一种起搏技术，以区分近场（NF）和远场希氏束激动，从而避免该并发症。
方法与结果
对15只杂种犬和23例希氏束旁AP患者进行了右心室三维标测。使用不同的起搏输出，在心室面识别出NF和远场希氏束激动。对8只犬（第1组）的NF希氏束部位和7只犬（第2组）的远场希氏束部位进行射频消融，14天后进行病理检查。10只犬以5 mA/1 ms、5只犬以10 mA/1 ms捕获到NF希氏束激动。在第1组中，射频消融导致3只犬出现完全性房室传导阻滞，1只犬出现右束支传导阻滞伴HV（希氏束至心室）间期延长，2只犬仅出现右束支传导阻滞，而第2组未发生变化。第1组犬的病理检查显示，4只犬希氏束完全或部分坏死，5只犬右束支完全坏死。在第2组中，仅1只犬右束支出现部分坏死。使用该起搏技术，20例患者的AP位于希氏束上方5.7±1.2 mm处，3例患者的AP位于希氏束下方。所有AP均通过1至3次射频消融成功消除。在11.8±1.4个月的随访期间未发生并发症和复发。
结论
区分NF希氏束和远场希氏束激动可使希氏束旁AP患者在无房室传导阻滞的情况下获得较高的消融成功率。
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