Weerasooriya H R, Murdock C J, Davis M J
University of Western Australia, Crawley.
Med J Aust. 1993 Jul 19;159(2):97-102.
To describe our initial experience with transcatheter radiofrequency ablation, a useful new treatment for supraventricular tachyarrhythmias related to the presence of an accessory atrioventricular (AV) pathway or dual atrioventricular nodal pathways.
One hundred and ten patients, including 77 with accessory pathways, 32 with dual atrioventricular (AV) nodal pathways and one with both, underwent electrophysiological studies and were treated with transcatheter radiofrequency ablation in a large metropolitan teaching hospital.
Ninety-five patients (86%) were without evidence of accessory pathway conduction or inducible supraventricular tachycardia and were free of symptoms after a mean follow-up of 13 months (range, 3.0-51 months). Sixty-six of 79 accessory pathways (83.5%) were ablated including 42 of 46 left-sided (91%), 14 of 21 posteroseptal (66%), six of seven anteroseptal (86%), three of four right-sided and one of one midseptal pathways. Thirty-one patients with AV nodal reentry were successfully treated by ablation of either the slow (12 patients) or fast (19 patients) conducting AV nodal pathway. There was a progressive improvement in the success rate of the first procedure from 17% to 64% with the use of large-tip catheters and from 64% to 91% when a purpose-built radiofrequency generator was employed. Complications occurred in nine patients: cardiac tamponade (two patients); mild mitral regurgitation (four); subclavian vein thrombosis (one); transient cerebral ischaemic attack (one); and non-thrombocytic purpuric rash (one). These occurred predominantly during the early experience and were without long-term sequelae. Late in our experience, one patient developed complete atrioventricular block requiring permanent pacemaker implantation.
In this institution, radiofrequency catheter ablation has been a safe and effective treatment strategy for patients with life-threatening or highly symptomatic supraventricular arrhythmias.
描述我们经导管射频消融术的初步经验，这是一种治疗与房室旁道或双房室结径路相关的室上性快速心律失常的有效新方法。
110例患者，其中77例有旁道，32例有双房室结径路，1例两者皆有，在一家大型都市教学医院接受了电生理检查并接受经导管射频消融治疗。
95例患者（86%）无旁道传导或可诱发的室上性心动过速证据，平均随访13个月（3.0 - 51个月）后无症状。79条旁道中的66条（83.5%）被消融，包括46条左侧旁道中的42条（91%）、21条后间隔旁道中的14条（66%）、7条前间隔旁道中的6条（86%）、4条右侧旁道中的3条以及1条中间隔旁道。31例房室结折返患者通过消融慢传导（12例）或快传导（19例）房室结径路成功治疗。使用大顶端导管时，首次手术成功率从17%逐步提高到64%，采用专用射频发生器时从64%提高到91%。9例患者出现并发症：心脏压塞（2例）；轻度二尖瓣反流（4例）；锁骨下静脉血栓形成（1例）；短暂性脑缺血发作（1例）；非血小板减少性紫癜皮疹（1例）。这些主要发生在早期经验阶段，无长期后遗症。在我们的经验后期，1例患者发生完全性房室传导阻滞，需要植入永久性起搏器。
在本机构，射频导管消融术对于有危及生命或高度症状性室上性心律失常的患者是一种安全有效的治疗策略。
