Twidale N, Sutton K, Bartlett L, Dooley A, Winstanley S, Heddle W, Hassam R, Koutsounis H
Department of Medicine, Flinders Medical Centre, South Australia.
Pacing Clin Electrophysiol. 1993 Jun;16(6):1275-84. doi: 10.1111/j.1540-8159.1993.tb01714.x.
Patients with atrial fibrillation or atrial flutter (AF) are candidates for radiofrequency (RF) catheter ablation of the atrioventricular (AV) node with the aim being to control heart rate. As patients with AF can have markedly impaired ventricular function, information concerning the hemodynamic effects of AV node ablation using RF current would be valuable. Fourteen consecutive patients (mean age 65 +/- 3 years) with drug-resistant AF underwent AV node catheter ablation with RF current and had permanent pacemaker implantation. The mean left ventricular ejection fraction (EF) by two-dimensional echocardiography immediately before ablation was 42 +/- 3% (range 14%-54%) and their mean exercise time was 4.4 +/- 0.4 minutes. Complete AV block was achieved in all 14 patients with 6 +/- 2 RF applications (range 1-18). There was no evidence of any acute cardiodepressant effect associated with delivery of RF current, and EF 3 days after ablation was 44 +/- 4%. By 6 weeks after ablation, the left ventricular EF was significantly improved compared to baseline (47 +/- 4% postablation vs 42 +/- 3% preablation; P < 0.05), and this modest increase in EF was accompanied by an improvement in exercise time (5.4 +/- 0.4 min). In conclusion, delivery of RF current for AV node catheter ablation in patients with AF and reduced ventricular function is not associated with any acute cardiodepressant effect. On the contrary, improved control of rapid heart rate following successful AV node ablation is associated with a modest and progressive improvement in cardiac performance.
心房颤动或心房扑动（AF）患者是房室（AV）结射频（RF）导管消融的候选对象，目的是控制心率。由于AF患者的心室功能可能明显受损，有关使用RF电流进行AV结消融的血流动力学效应的信息将很有价值。连续14例（平均年龄65±3岁）耐药性AF患者接受了RF电流下的AV结导管消融并植入了永久性起搏器。消融前通过二维超声心动图测得的平均左心室射血分数（EF）为42±3%（范围14%-54%），平均运动时间为4.4±0.4分钟。14例患者均通过6±2次RF应用（范围1-18次）实现了完全性房室传导阻滞。没有证据表明与RF电流传递相关的任何急性心脏抑制作用，消融后3天的EF为44±4%。到消融后6周时，左心室EF与基线相比有显著改善（消融后为47±4%，消融前为42±3%；P<0.05），EF的这种适度增加伴随着运动时间的改善（5.4±0.4分钟）。总之，对于AF和心室功能降低的患者，RF电流用于AV结导管消融与任何急性心脏抑制作用无关。相反，成功进行AV结消融后对快速心率的更好控制与心脏功能的适度且渐进性改善相关。
