Kay G N, Epstein A E, Dailey S M, Plumb V J
Division of Cardiovascular Disease, University of Alabama at Birmingham 35294.
J Cardiovasc Electrophysiol. 1993 Aug;4(4):371-89. doi: 10.1111/j.1540-8167.1993.tb01277.x.
Several reports have demonstrated that radiofrequency catheter ablation provides effective control of a variety of supraventricular tachycardias. However, the efficacy, complications, risk of arrhythmia recurrence, and follow-up survival analysis have not been reported in a large series of consecutive patients with supraventricular arrhythmias with diverse electrophysiologic mechanisms. This report details the results of radiofrequency catheter ablation in 760 consecutive patients (386 males, 374 females) with a wide variety of supraventricular tachycardias treated at one center.
Arrhythmias were associated with the presence of an accessory pathway in 363 patients (384 accessory pathways), including four patients with Mahaim fibers and eight patients with the permanent form of junctional reciprocating tachycardia. The mechanism of the clinical arrhythmia was AV nodal reentrant tachycardia in 245 patients, and a primary atrial tachycardia in 20 patients (ectopic atrial tachycardia in 16 patients and sinus nodal reentry in 4 patients). Ablation of the reentrant circuit of atrial flutter within the right atrium was attempted in 13 patients. AV node ablation and permanent pacemaker implantation were performed in 119 patients with medically refractory atrial fibrillation or flutter. Radiofrequency catheter ablation was successful in 346 of 363 patients (95.3%, CI 93.1%-97.5%) with accessory pathways (367 of 384 pathways, 95.6%, CI 93.5%-97.6%) with a complication rate of 1.1% and a recurrence rate of 5.5%. Successful accessory pathway ablation was achieved for 179 of the first 192 pathways treated (93.2%, CI 89.7%-96.6%) and increased to 188 of 192 pathways (97.9%, CI 95.9%-99.9%) over the second half of the series. AV nodal reentry was successfully abolished in 244 of 245 patients (99.6%, CI 98.8%-100%) by selective ablation of the slow pathway in 234 patients and the fast pathway in 10 patients. The complication rate in this group was 2.0% with a recurrence rate of 6.5%. All 20 primary atrial tachycardias were successfully ablated with no complications and a recurrence rate of 15%. The reentrant circuit of atrial flutter was ablated successfully in 10 of 13 patients (77%) with recurrent atrial flutter in one additional patient. Complete AV block was achieved in 117 of 119 (98.3%, CI 96.0%-100%) patients with atrial fibrillation or flutter treated by AV nodal ablation with a complication rate of 0.8% and recurrence of AV conduction in 6%. The median duration of fluoroscopy exposure for the population was 23.4 minutes. The overall primary success rate for the entire population was 97.0% (737 of 760 patients, CI 95.8%-98.2%).
Thus, the results of this large series of patients demonstrates the safety and efficacy of radiofrequency ablation for the treatment of a wide variety of supraventricular arrhythmias. It also appears that increasing experience with these procedures increases the rate of successful ablation and decreases the risk of complications.
多项报告表明，射频导管消融术能有效控制多种室上性心动过速。然而，对于一大组具有不同电生理机制的连续性室上性心律失常患者，其疗效、并发症、心律失常复发风险及随访生存分析尚未见报道。本报告详细阐述了在一个中心接受治疗的760例连续性患者（男性386例，女性374例）各种室上性心动过速的射频导管消融结果。
363例患者（384条附加通路）的心律失常与附加通路有关，其中包括4例Mahaim纤维患者和8例永久性交界性折返性心动过速患者。临床心律失常的机制在245例患者中为房室结折返性心动过速，20例患者为原发性房性心动过速（16例为异位房性心动过速，4例为窦房结折返）。对13例患者尝试在右心房内消融房扑的折返环。119例药物难治性房颤或房扑患者接受了房室结消融及永久性起搏器植入。363例有附加通路的患者中，346例（95.3%，CI 93.1%-97.5%）射频导管消融成功（384条通路中的367条，95.6%，CI 93.5%-97.6%），并发症发生率为1.1%，复发率为5.5%。在前1�2条治疗的通路中，179条成功消融（93.2%，CI 89.7%-96.6%），在该系列的后半部分，192条通路中的188条成功消融（97.9%，CI 95.9%-99.9%）。245例患者中的244例（99.6%，CI 98.8%-100%）通过选择性消融慢径路（234例患者）和快径路（10例患者）成功消除房室结折返。该组并发症发生率为2.0%，复发率为6.5%。所有20例原发性房性心动过速均成功消融，无并发症，复发率为15%。13例患者中的10例（77%）房扑折返环成功消融，另有1例患者复发房扑。119例接受房室结消融治疗的房颤或房扑患者中，117例（98.3%，CI 96.0%-100%）实现完全性房室传导阻滞，并发症发生率为0.8%，房室传导恢复率为6%。该人群透视暴露的中位持续时间为23.4分钟。整个人群的总体初次成功率为97.0%（760例患者中的737例，CI 95.8%-98.2%）。
因此，这一大组患者的结果证明了射频消融治疗多种室上性心律失常的安全性和有效性。似乎随着这些手术经验的增加，成功消融率提高，并发症风险降低。
