Trantham J L, Gallagher J J, German L D, Broughton A, Guarnieri T, Kasell J
J Clin Invest. 1983 Nov;72(5):1563-74. doi: 10.1172/JCI111115.
In this paper we summarize our experience and report the characteristics of energy delivery in 23 patients who have undergone closed chest ablation of the normal atrioventricular (AV) conduction system for the treatment of refractory supraventricular arrhythmias. The induction of AV block was achieved by the synchronous delivery of electrical energy with a damped sinusoidal waveform utilizing a standard direct current defibrillator and a standard tripolar His bundle catheter. The procedure was well tolerated, though one patient experienced ventricular fibrillation, which was uneventfully converted with external paddles. Complete AV block was achieved in 20 of 23 patients and all were rendered arrhythmia free, though two still required antiarrhythmic drugs. A stable escape rhythm was seen in all patients with a cycle length of 1,294 +/- 243 ms. Creatine phosphokinase-MB was positive at low levels in 19 of 23 patients and cleared within 24 h. 99mTc pyrophosphate scans were faintly positive in only 2 of 22 patients. Left ventricular wall motion and ejection fractions were unchanged in 19 of 19 patients, two-dimensional echocardiography with microcavitation technique was unchanged in 12 of 12 patients, and a slight increase in pulmonary artery wedge pressure was seen in only 1 of 11 patients. Current, voltage, and their product (power) waveforms were recorded in 12 patients (12 recordings at a defibrillator setting of 200 J and 5 recordings at a defibrillator setting of 300 J) and revealed a complex voltage-current relationship due to changes occurring at the catheter electrode-tissue interface. At 200 J the peak values were 42.2 +/- 3.3 A, 2.16 +/- 0.11 kV, and 87.9 +/- 4.7 kW, while at 300 J the peak values were 58.2 +/- 2.8 A, 2.40 +/- 0.10 kV, and 134.4 +/- 6.7 kW, respectively. No instance of catheter disruption was seen, though "pitting" of the distal electrode (through which current passed) occurred in all but one catheter.
在本文中，我们总结了自身经验，并报告了23例因治疗难治性室上性心律失常而接受正常房室（AV）传导系统闭合胸部消融术患者的能量传递特征。通过使用标准直流除颤器和标准三极希氏束导管，以衰减正弦波形同步传递电能来诱发房室传导阻滞。该手术耐受性良好，不过有1例患者发生心室颤动，通过体外除颤器顺利转复。23例患者中有20例实现了完全性房室传导阻滞，且所有患者均不再发生心律失常，尽管仍有2例需要抗心律失常药物治疗。所有患者均出现稳定的逸搏心律，周期长度为1294±243毫秒。23例患者中有19例肌酸磷酸激酶-MB呈低水平阳性，并在24小时内清除。22例患者中只有2例99m锝焦磷酸盐扫描呈弱阳性。19例患者中有19例左心室壁运动和射血分数未改变，12例患者中有12例采用微泡技术的二维超声心动图未改变，11例患者中只有1例肺动脉楔压略有升高。对12例患者记录了电流、电压及其乘积（功率）波形（在除颤器设置为200焦耳时记录12次，在除颤器设置为300焦耳时记录5次），结果显示由于导管电极与组织界面发生的变化，电压-电流关系复杂。在200焦耳时，峰值分别为42.2±3.3安培、2.16±0.11千伏和87.9±4.7千瓦，而在300焦耳时，峰值分别为58.2±2.8安培、2.40±0.10千伏和134.4±6.7千瓦。未见导管破裂情况，不过除1根导管外，所有导管的远端电极（电流通过的电极）均出现“点蚀”。
