Sousa J, Brandão L, Barreiros M C, Vagueiro M C
Serviço de Cardiologia, Hospital de Santa Maria, Lisboa.
Rev Port Cardiol. 1994 May;13(5):389-95, 379.
To assess the safety and efficacy of radiofrequency atrio-ventricular junctional ablation.
Consecutive group of patients with refractory atrial tachyarrhythmias in whom catheter ablation of the atrio-ventricular junction was performed.
Cardiology Department at University Hospital.
Atrio-ventricular junctional ablation was performed in 13 patients with a mean age of 53 +/- 13 years. Among six patients there was no evidence of organic heart disease, two had operated congenital heart disease, two had hypertensive heart disease, one had rheumatic heart disease with a prosthetic valve and the other had ischemic heart disease. The indication for ablation was drug-refractory atrial tachyarrhythmia in all patients: atrial fibrillation with uncontrolled rate in eight patients, atrial flutter in three, atrial tachycardia in one and inappropriate sinus tachycardia in one. An average of 3.7 +/- 0.9 anti-arrhythmia drugs was previously ineffective or associated with significant side-effects. Radiofrequency energy was applied between the distal pole of the ablation catheter and an indifferent cutaneous electrode with intensity of 40-65 volts for 30-60 secs. The ablation was initially performed utilizing the classical technique with the ablation catheter across the tricuspid valve. In the case of failure, an alternative method was used, with the ablation catheter positioned in the left ventricular septum. After the procedure a VVI-R permanent pacemaker was inserted in all patients.
Atrio-ventricular junctional ablation was successful in all patients after an average of 4.4 +/- 3.7 radiofrequency applications. The classical technique was successful in 11 patients (85%). The average amplitude of the His bundle electrogram recorded in the successful sites was not significantly different from the average maximum amplitude at unsuccessful sites (0.1 +/- 0.05 mV vs. 0.17 +/- 0.12 mV). There were no complications related to the procedures. During a mean follow-up of 7 +/- 4 months there was functional and symptomatic improvement in all patients. The only significant complication was an episode of sustained ventricular tachycardia that occurred three months after the ablation in a patient with Tetralogy of Fallot.
In patients with refractory atrial tachyarrhythmias, atrio-ventricular junctional ablation is a safe and effective therapeutic option. The alternative technique should be reserved for cases of unsuccessful ablation with the classic method. Due to its potential significant side-effects, this therapy should be a last alternative option.
评估射频房室交界区消融术的安全性和有效性。
对连续一组难治性房性快速心律失常患者进行房室交界区导管消融术。
大学医院心内科。
对13例平均年龄为53±13岁的患者进行了房室交界区消融术。其中6例无器质性心脏病证据，2例有先天性心脏病手术史，2例有高血压性心脏病，1例有风湿性心脏病伴人工瓣膜，另1例有缺血性心脏病。所有患者消融的指征均为难治性房性快速心律失常：8例房颤心率控制不佳，3例房扑，1例房性心动过速，1例不适当窦性心动过速。平均3.7±0.9种抗心律失常药物先前无效或伴有明显副作用。在消融导管的远端电极与体表无关电极之间施加射频能量，强度为40 - 65伏，持续30 - 60秒。最初采用经典技术，将消融导管穿过三尖瓣进行消融。若失败，则采用另一种方法，将消融导管置于左心室间隔。术后所有患者均植入VVI - R永久起搏器。
平均4.4±3.7次射频应用后，所有患者的房室交界区消融均成功。经典技术在11例患者（85%）中成功。在成功部位记录的希氏束电图平均振幅与未成功部位的平均最大振幅无显著差异（0.1±0.05毫伏对0.17±0.12毫伏）。未发生与手术相关的并发症。在平均7±4个月的随访期间，所有患者的功能和症状均有改善。唯一显著的并发症是1例法洛四联症患者在消融术后3个月发生持续性室性心动过速。
对于难治性房性快速心律失常患者，房室交界区消融是一种安全有效的治疗选择。替代技术应保留用于经典方法消融失败的病例。由于其潜在的显著副作用，该治疗应作为最后的替代选择。
