Kottkamp H, Hindricks G, Willems S, Chen X, Reinhardt L, Haverkamp W, Breithardt G, Borggrefe M
Department of Cardiology and Angiology, Hospital of the Westfälische Wilhelms-University, Münster, Germany.
J Am Coll Cardiol. 1995 Apr;25(5):974-81. doi: 10.1016/0735-1097(94)00509-o.
We describe a new stepwise anatomically and electrogram-guided strategy for radiofrequency catheter ablation of the fast pathway.
Anatomically and electrogram-guided approaches have been developed for slow pathway ablation in patients with atrioventricular (AV) node reentrant tachycardia; however, no stepwise systematic approaches exist for fast pathway ablation.
Fifty-three patients (mean [+/- SD] age 43 +/- 11 years) with AV node reentrant tachycardia underwent attempted ablation of the fast pathway. The ablation catheter was initially positioned posterior and slightly superior to the site of the maximal His bundle recording region. At these sites, the amplitude of the local atrial potential was usually at least twice as high as the local ventricular potential, and a small proximal His bundle potential was recorded. When the first pulse was ineffective, the ablation catheter was repositioned stepwise slightly inferior to more midseptal sites.
After a mean of 3.4 +/- 3.1 radiofrequency pulses (median 2, range 1 to 12), AV node reentrant tachycardia was noninducible in 51 patients (96%). No inadvertent complete AV block occurred. The AH interval was prolonged from 79 +/- 19 to 145 +/- 37 ms (p < 0.001). Thirty-eight patients (72%) developed complete ventriculoatrial block. Recording of a His bundle potential at the target site, stability of the local electrograms and occurrence of fast junctional rhythms during energy applications were more often observed at successful sites than transiently effective or noneffective sites. During a follow-up period of 12 +/- 7 months, 3 (6%) of 51 patients had a clinical recurrence of AV node reentrant tachycardia.
Radiofrequency catheter ablation of the fast pathway using a combined anatomically and electrogram-guided stepwise approach is highly effective and safe. The safety of this approach seems to be due to the stable position of the ablation catheter at the interatrial septum, rather than across the tricuspid annulus, and the larger distance to the central body of the AV node and bundle of His.
我们描述一种用于快速径路射频导管消融的新的逐步解剖学和心内电图引导策略。
已开发出解剖学和心内电图引导方法用于房室结折返性心动过速患者的慢径路消融；然而，对于快速径路消融不存在逐步的系统方法。
53例房室结折返性心动过速患者（平均[±标准差]年龄43±11岁）尝试进行快速径路消融。消融导管最初置于希氏束最大记录区域位点的后方且略上方。在这些位点，局部心房电位的幅度通常至少是局部心室电位的两倍，并且记录到小的近端希氏束电位。当第一个脉冲无效时，消融导管逐步重新定位至略下方至更靠近间隔中部的位点。
平均3.4±3.1次射频脉冲（中位数2，范围1至12）后，51例患者（96%）的房室结折返性心动过速不能被诱发。未发生意外的完全性房室传导阻滞。AH间期从79±19延长至145±37毫秒（p<0.001）。38例患者（72%）发生完全性室房传导阻滞。在成功位点比短暂有效或无效位点更常观察到在靶位点记录到希氏束电位、局部心内电图的稳定性以及能量施加期间快速交界性心律的发生。在12±7个月的随访期内，51例患者中有3例（6%）出现房室结折返性心动过速的临床复发。
使用解剖学和心内电图引导相结合的逐步方法进行快速径路射频导管消融是高度有效且安全的。该方法的安全性似乎归因于消融导管在房间隔的稳定位置，而非穿过三尖瓣环，以及与房室结中心体和希氏束的更大距离。
