经导管射频消融治疗间隔旁道房室旁道。

Radiofrequency catheter ablation of septal accessory atrioventricular pathways.

作者信息

Xie B, Heald S C, Bashir Y, Camm A J, Ward D E

机构信息

Department of Cardiological Sciences, St George's Hospital Medical School, London.

出版信息

Br Heart J. 1994 Sep;72(3):281-4. doi: 10.1136/hrt.72.3.281.

DOI:10.1136/hrt.72.3.281

PMID:7946782

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1025518/

Abstract

OBJECTIVE

Septal accessory atrioventricular pathways are recognised as being more difficult to ablate than pathways in other locations. This paper describes an experience of 48 consecutive patients with septal accessory pathways who had catheter ablation with radiofrequency current.

PATIENTS AND METHODS

There were 28 male and 20 female patients, mean (SD) age 35 (17). 43 patients had a single accessory pathway and 5 patients had multiple accessory pathways. Pre-excitation was present in 37 patients, and 11 patients had concealed accessory pathways. 21 patients had had a previous electrophysiological study. Catheter ablation was undertaken with radiofrequency current delivered by a standard unipolar technique or by delivery of current across the septum (the bipolar technique).

RESULTS

The median total procedure time was 167 (83) minutes including a 30-40 minute observation period after the abolition of conduction by the accessory pathway. The median total fluoroscopic time was 56 (30) minutes. 42 (88%) out of 48 patients had successful ablation of the pathway during the first session. In the six patients in whom the procedure failed, five had a midseptal pathway and one had a right anteroseptal pathway. A second attempt at ablation was made in two patients and succeeded in both. In total, 49 accessory pathways were successfully ablated in 44 (92%) out of 48 patients. The bipolar technique was used in 11 patients and succeeded in 10 patients. Standard unipolar current delivery had previously failed in seven of the 11 patients. Complications developed in two patients with a mid septal pathway (one with complete atrioventricular block and the other with a small pericardial effusion).

CONCLUSION

Radiofrequency catheter ablation of septal accessory pathways is efficacious and safe. The procedure time can be shortened and success rate can be increased after improvement of the technique--that is, consideration of a bipolar approach for energy delivery in difficult cases.

摘要

目的

与其他部位的房室旁道相比，间隔旁道被认为更难消融。本文描述了连续48例间隔旁道患者接受射频电流导管消融的经验。

患者与方法

患者中男性28例，女性20例，平均（标准差）年龄35（17）岁。43例患者有单一旁道，5例患者有多条旁道。37例患者有预激，11例患者有隐匿性旁道。21例患者曾接受过电生理检查。采用标准单极技术或经间隔输送电流（双极技术）进行射频电流导管消融。

结果

包括旁道传导消失后的30 - 40分钟观察期，总手术时间中位数为167（83）分钟。总透视时间中位数为56（30）分钟。48例患者中有42例（88%）在首次手术时成功消融旁道。在手术失败的6例患者中，5例有中间隔旁道，1例有右前间隔旁道。2例患者进行了第二次消融尝试，均成功。48例患者中有44例（92%）成功消融了49条旁道。11例患者使用了双极技术，10例成功。标准单极电流输送在这11例患者中有7例先前失败。2例中间隔旁道患者出现并发症（1例发生完全性房室传导阻滞，另1例有少量心包积液）。