Dechering Dirk G, Schleberger Ruben, Greiser Eva, Dickow Jannis, Koebe Julia, Frommeyer Gerrit, Willems Stephan, Eckardt Lars, Hoffmann Boris A, Wasmer Kristina
Division of Clinical and Experimental Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany.
Department of Cardiology - Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
J Interv Card Electrophysiol. 2018 Jul;52(2):157-161. doi: 10.1007/s10840-018-0360-0. Epub 2018 Mar 19.
Slow pathway modulation is the treatment of choice in patients with atrioventricular nodal reentrant tachycardia (AVNRT). No comparative data on ablation strategies exist. Therefore, we sought to compare two common ablation approaches.
We analyzed prospective ablation databases of two high-volume tertiary centers (> 1000 ablations/year) using either 30 or 50 W for slow pathway modulation from 2012 to 2013. We analyzed procedural characteristics as well as short- and long-term outcomes. Mean follow-up was 36 ± 9 months.
Six hundred thirty-four patients (50 W center: n = 342, 30 W center: n = 292) were ablated. Slow pathway modulation was successful in 99% in both groups (p = ns). Periprocedural AV block occurred in nine patients (2.6%) in the 50 W and five patients (1.7%) in the 30 W group (p = 0.59), respectively. We documented no permanent higher-degree AV block. The number of RF lesions and seconds of RF delivery was significantly less in the 50 W group (p = 0.04 for number of lesions; p < 0.001 for seconds). AVNRT recurrence was similar (p = 0.23). In males, significantly fewer recurrences accrued in the 50 W group (p = 0.04), while in females less transient AV blocks occurred during the procedure with 30 W (p = 0.07).
The 30 and 50 W target power approaches for slow pathway modulation are highly effective and safe. Significantly, fewer RF duration was necessary to modulate the slow pathway with higher power output (50 W). Our subgroup analysis suggests that males and females might benefit most from different modulation approaches.
慢径路改良是房室结折返性心动过速（AVNRT）患者的首选治疗方法。目前尚无关于消融策略的比较数据。因此，我们试图比较两种常见的消融方法。
我们分析了2012年至2013年期间两个高容量三级中心（每年消融>1000例）使用30W或50W进行慢径路改良的前瞻性消融数据库。我们分析了手术特征以及短期和长期结果。平均随访时间为36±9个月。
共消融634例患者（50W组：n = 342，30W组：n = 292）。两组慢径路改良成功率均为99%（p = 无显著性差异）。50W组9例患者（2.6%）和30W组5例患者（1.7%）发生围手术期房室传导阻滞（p = 0.59）。未记录到永久性高度房室传导阻滞。50W组的射频消融灶数量和射频发放时间明显更少（消融灶数量p = 0.04；时间p < 0.001）。AVNRT复发情况相似（p = 0.23）。在男性中，50W组的复发明显较少（p = 0.04），而在女性中，30W手术期间发生的短暂性房室传导阻滞较少（p = 0.07）。
30W和50W目标功率的慢径路改良方法高效且安全。值得注意的是，更高的功率输出（50W）调制慢径路所需的射频持续时间明显更少。我们的亚组分析表明，男性和女性可能从不同的调制方法中获益最大。
