Lee C S, Lai W T, Lin C C, Chang J S, Yen H W, Voon W C, Hwang Y Y, Lee J Y, Wu J C, Huang Y Y
Department of Internal Medicine, Kaohsiung Medical College, Taiwan, Republic of China.
Gaoxiong Yi Xue Ke Xue Za Zhi. 1994 Feb;10(2):52-62.
From January 1992 to June 1993, 100 consecutive patients with clinically documented paroxysmal supraventricular tachycardias underwent radiofrequency catheter ablation. Group 1 consisted of 46 patients (male:female = 9:37, age: 46 +/- 13 years) with slow-fast atrioventricular nodal reentrant tachycardia. Radiofrequency current was aimed at the slow pathway area which was identified by both anatomical and electrophysiological methods. A mean application of 8 +/- 9 was delivered at a mean power of 22 +/- 4 watts with a mean duration of 21 +/- 3 seconds. Selective ablation of slow pathway conduction was achieved in 28 patients and modification of slow pathway conduction in 12 patients. Antegrade fast pathway conduction was ablated in 3 patients, and retrograde fast pathway conduction in 1. Mean peak CPK was 156 +/- 117 IU/L after ablation. Neither AV block nor clinical recurrence was found during 9.7 +/- 5.1 months follow up. Group 2 consisted of 54 patients with accessory pathway (AP) mediated atrioventricular reciprocating tachycardia. For 35 patients (M:F = 21:14, age: 40 +/- 12 years) who had left-sided accessory pathway, catheter ablation was approached by the retrograde trans-aortic technique in 33 patients and by the transseptal left atrial approach through patent foramen ovale in 2 patients. The mean energy delivered was 28 +/- 5 watts for a duration of 27 +/- 12 sec and 9 +/- 8 applications. The accessory pathway conduction was successfully ablated in 30 patients (86%). Mean peak CPK was 392 +/- 534 IU/L. Cardiac tamponade occurred in 1 patient and transient cerebral ischemia in another, but without mortality. No clinical recurrence was found during 9 +/- 4 months follow-up. Nineteen patients (M:F = 7:12, age: 36 +/- 11 years) had right-sided AP. The mean energy required for successful ablation was 30 +/- 4 watts for a duration of 35 +/- 15 sec and 12 +/- 9 applications. Mean peak CPK was 147 +/- 70 IU/L. Clinical recurrence occurred in 3 patients (15.8%), 1 of them had subsequent successive ablation. The overall immediate procedure success rate for right-sided AP was 65%. In conclusion, radiofrequency catheter ablation is a safe and effective treatment modality for patients with paroxysmal supraventricular tachycardias.
1992年1月至1993年6月，100例临床确诊为阵发性室上性心动过速的患者接受了射频导管消融术。第1组由46例患者组成（男:女 = 9:37，年龄：46±13岁），患有慢-快型房室结折返性心动过速。射频电流作用于通过解剖和电生理方法确定的慢径区域。平均施加8±9次，平均功率为22±4瓦，平均持续时间为21±3秒。28例患者实现了慢径传导的选择性消融，12例患者慢径传导得到改良。3例患者顺向快径传导被消融，1例患者逆向快径传导被消融。消融后平均肌酸磷酸激酶（CPK）峰值为156±117 IU/L。在9.7±5.1个月的随访期间未发现房室传导阻滞或临床复发。第2组由54例经旁路（AP）介导的房室折返性心动过速患者组成。对于35例左侧旁路的患者（男:女 = 21:14，年龄：40±12岁），33例患者采用逆行经主动脉技术进行导管消融，2例患者通过卵圆孔未闭的经房间隔左心房途径进行消融。平均释放能量为28±5瓦，持续时间为27±12秒，施加9±8次。30例患者（86%）的旁路传导成功被消融。平均CPK峰值为392±534 IU/L。1例患者发生心脏压塞，另1例患者发生短暂性脑缺血，但均无死亡。在9±4个月的随访期间未发现临床复发。19例患者（男:女 = 7:12，年龄：36±11岁）有右侧AP。成功消融所需的平均能量为30±4瓦，持续时间为35±15秒，施加12±9次。平均CPK峰值为147±70 IU/L。3例患者（15.8%）出现临床复发，其中1例随后进行了再次消融。右侧AP的总体即刻手术成功率为65%。总之，射频导管消融术是阵发性室上性心动过速患者一种安全有效的治疗方式。
