Kay G N, Chong F, Epstein A E, Dailey S M, Plumb V J
Department of Medicine, University of Alabama, Birmingham 35294.
J Am Coll Cardiol. 1993 Mar 15;21(4):901-9. doi: 10.1016/0735-1097(93)90345-2.
The purpose of this study was to determine the safety and efficacy of radiofrequency ablation as definitive therapy for primary atrial tachycardias.
Primary atrial tachycardias are often difficult to control with antiarrhythmic medications and frequently require nonpharmacologic interventions for definitive therapy. Despite isolated reports of successful treatment of primary atrial tachycardias with radiofrequency ablation, the safety and efficacy of this technique have not been established in a larger series with long-term follow-up.
The immediate procedural success rate, associated complications and follow-up data of radiofrequency ablation were evaluated in 15 consecutive patients (11 adults and 4 children) with primary atrial arrhythmias that were refractory to medical management.
The clinical arrhythmia was ectopic atrial tachycardia in 11 patients and sinus node reentry in 4. The site of origin of the tachycardia was in the right atrium in 14 patients and in the left atrium in 1 patient (with two distinct foci) where the local atrial electrogram preceded the onset of the P wave by 10 to 30 ms. Radiofrequency energy successfully terminated the primary atrial tachycardia in each of the patients, and all were discharged from the electrophysiology laboratory in sinus rhythm without inducible atrial tachycardia. A mean of 10.8 +/- 9.9 radiofrequency applications were delivered using 30 W of power for 30 s. The local intracardiac activation time (relative to the P wave in the surface electrocardiogram) was a mean of -21 +/- 5 ms at the successful ablation site and -15 +/- 6 ms at unsuccessful sites (p < 0.001). No complications were observed, although one patient with incessant ectopic atrial tachycardia had sinus pauses after ablation. During a mean follow-up period of 277 +/- 133 days, the clinical arrhythmia recurred in three patients (20%, 95% confidence intervals 3% to 37%) including two patients with ectopic atrial tachycardia and one patient with sinus node reentry. One of these patients was successfully treated in a second ablation session.
Thus, radiofrequency catheter ablation appears to be a safe and effective technique for the treatment of primary atrial arrhythmias that are refractory to antiarrhythmic medications.
本研究旨在确定射频消融作为原发性房性心动过速的确定性治疗方法的安全性和有效性。
原发性房性心动过速通常难以用抗心律失常药物控制，常常需要非药物干预来进行确定性治疗。尽管有个别关于用射频消融成功治疗原发性房性心动过速的报道，但该技术的安全性和有效性尚未在更大规模且长期随访的系列研究中得到证实。
对15例（11例成人和4例儿童）药物治疗无效的原发性房性心律失常患者进行射频消融，评估其即刻手术成功率、相关并发症及随访数据。
临床心律失常中，11例为异位房性心动过速，4例为窦房结折返。心动过速起源部位，14例位于右心房，1例位于左心房（有两个不同的病灶），局部心房电图在P波起始前10至30毫秒。射频能量成功终止了每位患者的原发性房性心动过速，所有患者均以窦性心律从电生理实验室出院，且无诱发性房性心动过速。平均使用30瓦功率持续30秒进行了10.8±9.9次射频应用。成功消融部位的局部心内激动时间（相对于体表心电图中的P波）平均为-21±5毫秒，未成功部位为-15±6毫秒（p<0.001）。未观察到并发症，尽管1例持续性异位房性心动过速患者在消融后出现窦性停搏。在平均277±133天的随访期内，3例患者（20%，95%置信区间3%至37%）出现临床心律失常复发，包括2例异位房性心动过速患者和1例窦房结折返患者。其中1例患者在第二次消融术中成功治疗。
因此，射频导管消融似乎是治疗对抗心律失常药物无效的原发性房性心律失常的一种安全有效的技术。
