Arrhythmia Unit, Cardiology Service, University General Hospital of Alicante, Alicante Institute of Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain.
Electrophysiology Laboratory and Arrhythmia Unit, Hospital Monteprincipe, Grupo HM Hospitales, University CEU-San Pablo, Madrid, Spain.
J Interv Card Electrophysiol. 2020 Apr;57(3):333-343. doi: 10.1007/s10840-018-0448-6. Epub 2018 Sep 21.
Ablation of atrioventricular (AV) conduction and pacemaker implantation is the therapy of last resort for symptomatic atrial tachyarrythmias when rhythm and rate control fail, but is far from ideal. To evaluate whether interatrial electrical disconnection as a result of catheter ablation is feasible and of potential clinical utility as a means of non-pharmacological heart rate control.
Eleven patients with medically refractory atrial fibrillation or left atrial flutter and symptomatic rapid ventricular response were included. The ablation strategy consisted primarily of right atrial ablation of the interatrial electrical connections, which were located by electroanatomical activation maps performed during coronary sinus stimulation. Successive activation maps were performed as each connection was blocked. If the procedure was considered unsuccessful AV nodal ablation was performed.
The coronary sinus ostium was earliest in 10/11 and could be ablated in 5/10 patients. Interatrial conduction block was only achieved in one patient (9.1%). An unexpected AV nodal modulation with an increase in the Wenckebach cycle length (> 50 ms) occurred in 8/11 patients. These patients remained without pacemaker implantation and only 1/8 required AV nodal ablation during the 1-year follow-up. Quality of life questionnaires indicated significant improvement in patients with AV nodal modulation.
Interatrial electrical disconnection by right atrial catheter ablation is a not feasible with present day technology. The extensive right atrial septal ablation performed resulted in significant AV nodal modulation in most patients, which persisted and resulted in improvement in quality of life.
当节律和心率控制失败时，房室（AV）传导消融和起搏器植入是治疗症状性房性心动过速的最后手段，但远非理想。评估导管消融导致的房间隔电分离是否可行，以及作为非药物性心率控制手段是否具有潜在的临床应用价值。
纳入 11 例药物难治性心房颤动或左房扑动伴快速心室反应症状的患者。消融策略主要包括通过在冠状窦刺激期间进行的电解剖激活图来消融右心房的房间隔电连接。随着每个连接的阻断，进行连续的激活图。如果认为该程序不成功，则进行房室结消融。
11 例患者中，10/11 例冠状窦口最早，5/10 例可消融。仅 1 例患者（9.1%）实现了房间隔传导阻滞。8/11 例患者出现意外的房室结调制，文氏周期长度增加（>50 毫秒）。这些患者仍未植入起搏器，仅 1/8 例在 1 年随访期间需要房室结消融。生活质量问卷表明，AV 结调制的患者生活质量显著改善。
目前的技术水平无法通过右心房导管消融实现房间隔电分离。广泛的右房间隔消融导致大多数患者出现明显的房室结调制，这种调制持续存在并导致生活质量的改善。
