Wong J, Vohra J, Chan W, Mond H G, Lichtenstein M, Kritharides L, Warren R J
Department of Cardiology, Royal Melbourne Hospital, Vic.
Aust N Z J Med. 1996 Feb;26(1):82-8. doi: 10.1111/j.1445-5994.1996.tb02911.x.
There is limited information available regarding the effect of catheter ablation of the antioventricular (AV) junction on left ventricular (LV) function. Both deterioration and improvement in LV function have been reported following direct current (DC) ablation of the AV junction. The deterioration of LV function following DC ablation of the AV junction may be due to the accompanying barotrauma, DC arcing and direct coagulation, or even the effects of chronic ventricular pacing. If this deterioration of LV function was a result of the accompanying effects of DC shock, the use of radiofrequency ablation (RF) should not result in deterioration of LV function.
To study LV function before and after different methods of AV junction ablation and in patients with chronic ventricular pacing without AV junction ablation.
This study assessed LV function in patients following RF ablation, low energy DC ablation of the AV junction and compared the results with our previously reported finding in patients who had AV junction ablation using high energy DC shock. A group of patients undergoing permanent single chamber ventricular pacemaker implantation without AV junction ablation were selected as controls.
All patients were paced in the ventricle at 110 beats/minute during LV function assessment by radionuclide angiography. Global LV function and segmental wall motion abnormalities were assessed before, immediately following and three months after ablation.
In the high energy DC ablation group, a fall in global LV function (50 +/- 3.0% to 43 +/- 3.0%, p = 0.02) and impairment of segmental wall motion were detected. Low energy DC ablation resulted in segmental wall motion impairment similar to high energy DC but without affecting global ejection fraction (47.0% +/- 6.7 to 45.5% +/- 3.1, p > 0.05). Neither RF ablation (44.0% +/- 3.3 to 45.3% +/- 3.5, p > 0.05), nor chronic pacing (46.7% +/- 4.9 to 47.0% +/- 2.9 p > 0.05) had any effect on global or segmental LV function.
Low energy DC or RF ablation of the AV junction does not affect global LV ejection fraction. The deterioration of global LV function after high energy DC shock ablation appears to be related to the accompanying effects of DC energy and not to the effects of chronic ventricular pacing.
关于房室交界区导管消融对左心室（LV）功能的影响，目前可用信息有限。直流电（DC）消融房室交界区后，左心室功能既有恶化的报道，也有改善的报道。直流电消融房室交界区后左心室功能恶化可能是由于伴随的气压伤、直流电弧和直接凝血，甚至是慢性心室起搏的影响。如果左心室功能的这种恶化是直流电击的伴随效应导致的，那么使用射频消融（RF）不应导致左心室功能恶化。
研究不同方法消融房室交界区前后以及慢性心室起搏但未消融房室交界区患者的左心室功能。
本研究评估了射频消融、低能量直流电消融房室交界区患者的左心室功能，并将结果与我们之前报道的使用高能量直流电击消融房室交界区患者的结果进行比较。选择一组接受永久性单腔心室起搏器植入且未消融房室交界区的患者作为对照。
在通过放射性核素血管造影评估左心室功能期间，所有患者均以每分钟110次的频率进行心室起搏。在消融前、消融后即刻和消融后三个月评估左心室整体功能和节段性室壁运动异常。
在高能量直流电消融组中，检测到左心室整体功能下降（从50±3.0%降至43±3.0%，p = 0.02）以及节段性室壁运动受损。低能量直流电消融导致节段性室壁运动受损，与高能量直流电消融相似，但不影响整体射血分数（从47.0%±6.7降至45.5%±3.1，p>0.05）。射频消融（从44.0%±3.3降至45.3%±3.5，p>0.05）和慢性起搏（从46.7%±4.9降至47.0%±2.9，p>0.05）对左心室整体或节段性功能均无任何影响。
低能量直流电或射频消融房室交界区不影响左心室整体射血分数。高能量直流电击消融后左心室整体功能的恶化似乎与直流能量的伴随效应有关，而非慢性心室起搏的影响。
