Sathe S, Vohra J, Chan W, Wong J, Gerloff J, Riters A, Hall R, Hunt D
Department of Cardiology, Royal Melbourne Hospital, Vic., Australia.
Aust N Z J Med. 1993 Jun;23(3):317-24. doi: 10.1111/j.1445-5994.1993.tb01748.x.
Paroxysmal Supraventricular Tachycardia (PSVT) is a common condition which until recently has been treated with anti-arrhythmic drugs or surgery. Radiofrequency (RF) catheter ablation is a new mode of treatment which provides a cure of this condition.
To present our early experience of RF catheter ablation for PSVT.
One hundred and thirty-five procedures were performed in 117 patients. The diagnostic study and therapeutic catheter ablation were performed as a combined electrophysiological procedure in 74 patients (63%). In 58 patients (50%), PSVT was due to Atrio-ventricular junctional (nodal) re-entrant tachycardia (AVJRT). Twenty-five of the 58 patients underwent a fast pathway ablation while 33 had ablation of their slow pathway. The mean number of radiofrequency pulses delivered was ten for a mean duration of 25 seconds. Radiofrequency ablation of accessory pathways was attempted in 58 patients; pathways were left-sided in 29 patients, postero-septal in 21, midseptal in five, Mahaim connection in two, antero-septal in one and right free wall in one patient. One patient with incessant automatic atrial tachycardia also underwent a successful RF ablation.
Using RF ablation cure of PSVT was achieved in 90% of patients. Cure of AVJRT was achieved in 95% (55/58) of patients using either fast or slow pathway ablation. Only one patient required permanent pacemaker implantation for Mobitz type I AV block following fast pathway ablation. The overall success rate for ablation of accessory pathways was 85%. There is an operator learning curve for this procedure suggested by the fact that the success rate for accessory pathway ablation at first attempt was 63% in the first 29 patients and 93% in the remaining 29. There was no significant morbidity or mortality during or after the procedure. In a mean follow-up of nine months in the patients with successful ablation only two patients with AVJRT had a recurrence of documented PSVT. Both these patients had successful repeat RF ablation. Catheter ablation using radiofrequency energy is an effective and safe therapeutic option for patients with symptomatic PSVT.
阵发性室上性心动过速（PSVT）是一种常见病症，直到最近一直通过抗心律失常药物或手术进行治疗。射频（RF）导管消融术是一种新的治疗方式，可治愈这种病症。
介绍我们应用RF导管消融术治疗PSVT的早期经验。
对117例患者进行了135次手术。74例患者（63%）将诊断性研究和治疗性导管消融作为联合电生理手术进行。58例患者（50%）的PSVT是由房室交界区（结性）折返性心动过速（AVJRT）引起的。58例患者中有25例进行了快径路消融，33例进行了慢径路消融。平均发放的射频脉冲数为10个，平均持续时间为25秒。对58例患者尝试进行旁路消融；29例患者的旁路位于左侧，21例位于后间隔，5例位于中间隔，2例为Mahaim连接，1例位于前间隔，1例位于右游离壁。1例持续性自律性房性心动过速患者也成功进行了RF消融。
应用RF消融术，90%的患者治愈了PSVT。采用快径路或慢径路消融，95%（55/58）的患者治愈了AVJRT。快径路消融后，仅1例患者因莫氏I型房室传导阻滞需要植入永久性起搏器。旁路消融的总体成功率为85%。该手术存在操作者学习曲线，这一事实表明，前29例患者首次尝试旁路消融的成功率为63%，其余29例为93%。手术期间及术后均无明显的发病率或死亡率。成功消融的患者平均随访9个月，只有2例AVJRT患者记录到PSVT复发。这2例患者再次进行RF消融均获成功。对于有症状的PSVT患者，使用射频能量进行导管消融是一种有效且安全的治疗选择。
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