Katritsis Demosthenes G, Siontis Konstantinos C, Agarwal Sharad, Stavrakis Stavros, Giazitzoglou Eleftherios, Amin Hina, Marine Joseph E, Tretter Justin T, Sanchez-Quintana Damian, Anderson Robert H, Calkins Hugh
Hygeia Hospital Athens, Greece.
Johns Hopkins Hospital Baltimore, MD US.
Arrhythm Electrophysiol Rev. 2024 Aug 20;13:e12. doi: 10.15420/aer.2024.13. eCollection 2024.
Atrioventricular (AV) conduction ablation has been achieved by targeting the area of penetration of the conduction axis as defined by recording a His bundle potential. Ablation of the His bundle may reduce the possibility of a robust junctional escape rhythm. It was hypothesised that specific AV nodal ablation is feasible and safe.
The anatomical position of the AV node in relation to the site of penetration of the conduction axis was identified as described in dissections and histological sections of human hearts. Radiofrequency (RF) ablation was accomplished based on the anatomical criteria.
Specific anatomical ablation of the AV node was attempted in 72 patients. Successful AV nodal ablation was accomplished in 63 patients (87.5%), following 60 minutes (IQR 50-70 minutes) of procedure time, 3.4 minutes (IQR 2.4-5.5 minutes) of fluoroscopy time, and delivery of 4 (IQR 3-6) RF lesions. An escape rhythm was present in 45 patients (71%), and the QRS complex was similar to that before ablation in all 45 patients. Atropine was administered in six patients after the 10-min waiting period and did not result in restoration of conduction. In nine patients, AV conduction could not be interrupted, and AV block was achieved with ablation of the His after delivery of 12 (IQR 8-15) RF lesions. No cases of sudden death were encountered, and all patients had persistent AV block during a median 10.5 months (IQR 5-14 months) of follow-up.
Anatomical ablation of the AV node is feasible and safe, and results in an escape rhythm similar to that before ablation.
通过靶向希氏束电位所定义的传导轴穿透区域来实现房室传导消融。希氏束消融可能会降低出现强有力的交界性逸搏心律的可能性。据推测，特异性房室结消融是可行且安全的。
按照人体心脏解剖和组织学切片中所描述的方法，确定房室结相对于传导轴穿透部位的解剖位置。基于解剖学标准进行射频消融。
对72例患者尝试进行房室结的特异性解剖消融。63例患者（87.5%）成功完成房室结消融，手术时间为60分钟（四分位间距50 - 70分钟），透视时间为3.4分钟（四分位间距2.4 - 5.5分钟），发放4次（四分位间距3 - 6次）射频损伤。45例患者（71%）出现逸搏心律，所有45例患者的QRS波群与消融前相似。10分钟等待期后，6例患者给予阿托品，未恢复传导。9例患者房室传导未被阻断，在发放12次（四分位间距8 - 15次）射频损伤后消融希氏束实现了房室传导阻滞。未发生猝死病例，所有患者在中位随访10.5个月（四分位间距5 - 14个月）期间均持续存在房室传导阻滞。
房室结的解剖消融是可行且安全的，并且产生的逸搏心律与消融前相似。
