Strickberger S A, Foster P R, Wang P J, Okishige K, Friedman P L
Cardiac Arrhythmia Service, Brigham and Women's Hospital, Boston, MA 02115.
Pacing Clin Electrophysiol. 1993 Oct;16(10):1984-93. doi: 10.1111/j.1540-8159.1993.tb00992.x.
The effects of selective infusion of 25% ethanol into the AV nodal artery was assessed in 11 patients with atrial fibrillation and uncontrollably rapid ventricular response rates. The primary study objective was to achieve permanent modification of AV nodal function and control ventricular rate without drug therapy and without causing permanent complete AV block. "Clinical success" was defined as drug-free rate control by either AV nodal modification or the production of complete AV block. Selective catheterization and ethanol infusion into the AV nodal artery could be performed in nine patients. Intracoronary ethanol infusion acutely caused second- or third-degree AV nodal block in seven patients and an increase in AV nodal refractory period and Wenckebach cycle length in two patients. Acute occlusion of the AV nodal artery or infarction of nontarget myocardium was not observed. During follow-up of 22.2 +/- 2.2 months the primary study objective was attained in only four of nine patients treated, yielding an efficacy of 44%. However, the "clinical success" rate was 78%. The acute effects of ethanol on AV conduction did not predict the chronic effects. Selective intracoronary infusion of dilute ethanol to control the ventricular rate in atrial fibrillation should be considered when radiofrequency ablation has been unsuccessful. This method of chemical ablation is as effective and probably safer than rapid administration of 96% ethanol.
在11例心房颤动且心室反应率控制不佳的患者中，评估了选择性向房室结动脉注入25%乙醇的效果。主要研究目标是在不进行药物治疗且不导致永久性完全性房室传导阻滞的情况下，实现房室结功能的永久性改变并控制心室率。“临床成功”定义为通过房室结改良或产生完全性房室传导阻滞实现无药物心率控制。9例患者能够进行选择性导管插入术并向房室结动脉注入乙醇。冠状动脉内注入乙醇急性导致7例患者出现二度或三度房室传导阻滞，2例患者房室结不应期延长和文氏周期长度增加。未观察到房室结动脉急性闭塞或非靶心肌梗死。在22.2±2.2个月的随访期间，接受治疗的9例患者中只有4例达到了主要研究目标，有效率为44%。然而，“临床成功”率为78%。乙醇对房室传导的急性影响无法预测其慢性影响。当射频消融失败时，应考虑选择性冠状动脉内注入稀释乙醇来控制心房颤动的心室率。这种化学消融方法与快速给予96%乙醇一样有效，且可能更安全。
