Mehdirad A A, Keim S, Rist K, Tchou P
Department of Medicine, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pennsylvania, USA.
Pacing Clin Electrophysiol. 1995 Dec;18(12 Pt 1):2135-43. doi: 10.1111/j.1540-8159.1995.tb04638.x.
The study assessed the long-term outcome of patients undergoing radiofrequency ablation of the right bundle for bundle branch reentrant ventricular tachycardia. Bundle branch reentrant tachycardia was diagnosed in 16 patients (ejection fraction 31% +/- 15%) who underwent electrophysiology study in our laboratory. All patients had His-Purkinje system conduction delay with mean HV interval of 68 +/- 8 ms. After ablation, right bundle branch block developed in 15 patients. One patient developed complete heart block, which was anticipated. One patient died of heart failure 9 months after ablation. Two patients were successfully bridged to heart transplantation 0.5 and 13 months, respectively, after ablation. Two patients received implantable defibrillators for other ventricular tachycardias. One patient had syncope 11 months after ablation, but there was no evidence of ventricular tachycardia or heart block in repeat electrophysiology study. This patient died suddenly 29 months after ablation. The remaining nine patients were alive and well for a mean follow-up of 19 +/- 10 months. Radiofrequency ablation of the right bundle branch is an effective therapy for treatment of bundle branch reentrant ventricular tachycardia. Survival is excellent provided that other types of ventricular tachycardia, when present, are treated as well. This technique may be helpful in management of patients who have unacceptable frequent shocks from their implanted defibrillators and may be helpful in avoiding implantation of such a device completely in others. In some patients with terminal heart failure and incessant ventricular tachycardia, this procedure can function as a bridge to cardiac transplantation.
该研究评估了接受右束支射频消融术治疗束支折返性室性心动过速患者的长期预后。在我们实验室接受电生理检查的16例患者（射血分数31%±15%）中诊断出束支折返性心动过速。所有患者均有希氏-浦肯野系统传导延迟，平均HV间期为68±8毫秒。消融术后，15例患者出现右束支传导阻滞。1例患者出现完全性心脏传导阻滞，这是预期中的情况。1例患者在消融术后9个月死于心力衰竭。2例患者分别在消融术后0.5个月和13个月成功过渡到心脏移植。2例患者因其他室性心动过速接受了植入式除颤器。1例患者在消融术后11个月出现晕厥，但重复电生理检查未发现室性心动过速或心脏传导阻滞的证据。该患者在消融术后29个月突然死亡。其余9例患者存活良好，平均随访19±10个月。右束支射频消融术是治疗束支折返性室性心动过速的有效方法。如果同时存在其他类型的室性心动过速并得到妥善治疗，生存率会很高。这项技术可能有助于处理植入式除颤器频繁电击无法耐受的患者，也可能有助于完全避免在其他患者中植入此类设备。在一些终末期心力衰竭且持续性室性心动过速的患者中，该手术可作为心脏移植的桥梁。
