Menafoglio A, Schläpfer J, Kappenberger L, Former M
Division de cardiologie, Centre hospitalier universitaire vaudois (CHUV), Lausanne.
Schweiz Med Wochenschr. 1996 May 25;126(21):915-23.
Atrioventricular nodal reentrant tachycardia (AVNRT) is the most frequent paroxysmal supraventricular tachycardia and results from reentry in the atrioventricular nodal region via slow and fast pathways. The curative treatment of choice consists of selective radio-frequency catheter ablation of the slow pathway. In this retrospective study we report our experience of 73 consecutive patients suffering from AVNRT treated by selective slow pathway ablation and also review some features of AVNRT. AVNRT appeared for the first time at the age of 29 +/- 15 years and lasted for 17 +/- 13 years. In 37% of the patients AVNRT recurred at least weekly, 10% presented with syncope and 15% were admitted to hospital more than 5 times. On average, 2.5+/-1.6 drugs were prescribed to 66 of the 73 patients and 83% of them were drug-refractory. Selective slow pathway ablation was successfully performed in 65 patients (89%). The procedure, although effective, was complicated by atrioventricular block in 2 patients (2.7%) and failed in 6 patients. In 5 of them, fast pathway ablation was attempted and was successful in 2 cases, resulted in atrioventricular block in one case and failed in 2 cases. The complications, apart from atrioventricular block necessitating a pacemaker in all cases, were one pulmonary embolism and 2 pneumothorax. The mean follow-up for the 70 patients for whom ablation was effective (with or without atrioventricular block) is 12.7+/-7.3 months. AVNRT relapsed in 5 patients (7%); all of them underwent a second ablation with 4 successes (slow pathway) and one atrioventricular block (fast pathway after failed slow pathway ablation). 11 patients (16%) developed palpitations: in one case they were due to atrial fibrillation and in 10 cases they remained of unknown origin. The palpitations were of short duration and well tolerated, and these patients nevertheless felt an improvement after the ablation. Therefore, at medium term, 62 patients (85%) remained free from symptoms or only slightly symptomatic and without a pacemaker, and 51 of them (70%) remained completely asymptomatic and without a pacemaker. AVNRT can result in considerable morbidity and antiarrhythmic drugs are frequently ineffective. Slow pathway ablation is a safe and effective treatment for AVNRT. In our opinion, if AVNRT or medical treatment diminish the quality of life, ablation is indicated. When AVNRT presents with hemodynamic collapse, ablation is mandatory. Fast pathway ablation after failed slow pathway ablation is associated with a high incidence of atrioventricular block and is targeted only at very symptomatic patients who accept the possibility of definitive pacemaker implantation.
房室结折返性心动过速（AVNRT）是最常见的阵发性室上性心动过速，由房室结区域经慢径和快径折返引起。首选的根治性治疗方法是选择性射频导管消融慢径。在这项回顾性研究中，我们报告了73例连续接受选择性慢径消融治疗的AVNRT患者的经验，并回顾了AVNRT的一些特征。AVNRT首次出现的年龄为29±15岁，病程为17±13年。37%的患者AVNRT至少每周复发一次，10%的患者出现晕厥，15%的患者住院超过5次。73例患者中的66例平均服用2.5±1.6种药物，其中83%的患者药物治疗无效。65例患者（89%）成功进行了选择性慢径消融。该手术虽然有效，但有2例患者（2.7%）出现房室传导阻滞并发症，6例患者手术失败。其中5例尝试快径消融，2例成功，1例导致房室传导阻滞，2例失败。并发症除所有病例均因房室传导阻滞需要植入起搏器外，还有1例肺栓塞和2例气胸。70例消融有效的患者（无论有无房室传导阻滞）的平均随访时间为12.7±7.3个月。5例患者（7%）AVNRT复发；他们均接受了第二次消融，4例成功（慢径），1例出现房室传导阻滞（慢径消融失败后快径消融）。11例患者（16%）出现心悸：1例是由于心房颤动，10例原因不明。心悸持续时间短且耐受性良好，但这些患者在消融后仍感觉有所改善。因此，中期时，62例患者（85%）无症状或仅有轻微症状且无需起搏器，其中51例（70%）完全无症状且无需起搏器。AVNRT可导致相当大的发病率，抗心律失常药物常常无效。慢径消融是治疗AVNRT的一种安全有效的方法。我们认为，如果AVNRT或药物治疗降低了生活质量，则应进行消融治疗。当AVNRT出现血流动力学崩溃时，必须进行消融治疗。慢径消融失败后进行快径消融与房室传导阻滞的高发生率相关，仅适用于接受确定性起搏器植入可能性的症状非常严重的患者。
