Bogun F, Knight B, Weiss R, Bahu M, Goyal R, Harvey M, Daoud E, Man K C, Strickberger S A, Morady F
Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109-0022, USA.
J Am Coll Cardiol. 1996 Oct;28(4):1000-4. doi: 10.1016/s0735-1097(96)00258-6.
The purpose of this study was to assess the clinical efficacy of radiofrequency ablation of the slow pathway in patients with documented but noninducible paroxysmal supraventricular tachycardia (PSVT) who have evidence of dual atrioventricular (AV) node pathways.
Patients with a documented history of PSVT at times do not have inducible PSVT in the electrophysiology laboratory. Because dual AV node pathways serve as the substrate for AV node reentrant tachycardia (AVNRT), ablation of the slow pathway potentially may be useful in these patients.
The subjects in this prospective study were seven consecutive patients who underwent an electrophysiologic procedure because of documented PSVT and were found to have dual AV node physiology or inducible single AV node echo beats, but no inducible PSVT despite the administration of isoproterenol and atropine. Their mean (+/- SD) age was 33 +/- 13 years, and they had been symptomatic for 12 +/- 12 years. The frequency of the episodes of PSVT ranged from > or = 1/day to 1/month. The rate of the documented episodes ranged from 170 to 260 beats/min, and discrete P waves were not apparent. Slow pathway ablation was performed with 9 +/- 4 applications of radiofrequency energy using a combined anatomic and electrogram mapping approach.
All evidence of dual AV node pathways was eliminated in six patients, and dual AV node physiology remained present in one patient. During a mean follow-up period of 15 +/- 10 months (range 8 to 27), no patient had a recurrence of symptomatic tachycardia (success rate 95% confidence interval 65% to 100%).
Slow pathway ablation may be clinically useful in patients with documented but noinducible PSVT who have evidence of dual AV node pathways.
本研究旨在评估射频消融慢径路治疗有记录但不能诱发的阵发性室上性心动过速（PSVT）且有双房室（AV）结径路证据患者的临床疗效。
有PSVT记录病史的患者有时在电生理实验室不能诱发PSVT。由于双AV结径路是房室结折返性心动过速（AVNRT）的基础，消融慢径路可能对这些患者有用。
本前瞻性研究的受试者为7例连续患者，因有记录的PSVT接受电生理检查，发现有双AV结生理或可诱发的单个AV结回波，但尽管给予异丙肾上腺素和阿托品仍不能诱发PSVT。他们的平均（±标准差）年龄为33±13岁，有症状已12±12年。PSVT发作频率为≥1次/天至1次/月。记录的发作心率为170至260次/分钟，未见明显离散P波。采用解剖和电图联合标测方法，应用9±4次射频能量进行慢径路消融。
6例患者双AV结径路的所有证据均被消除，1例患者仍存在双AV结生理。在平均15±10个月（范围8至27个月）的随访期间，无患者出现症状性心动过速复发（成功率95%可信区间65%至100%）。
对于有记录但不能诱发的PSVT且有双AV结径路证据的患者，慢径路消融可能具有临床应用价值。
