Ellenbogen K A, Wood M A, Stambler B S
Division of Cardiology, Medical College of Virginia, Richmond 23298-0053, USA.
Pacing Clin Electrophysiol. 1996 Sep;19(9):1287-95. doi: 10.1111/j.1540-8159.1996.tb04206.x.
We studied the safety of performing RF catheter ablation in patients with implanted permanent pacemakers by monitoring the function of implanted pacing systems before, during, and immediately after exposure to RF energy. Patients with implanted pacing systems may require RF ablation for treatment of a variety of tachyarrhythmias. High frequency electromagnetic fields, such as RF energy, may affect implanted pacing systems, causing temporary or permanent loss of output, undersensing, oversensing, asynchronous pacing, or reversion to "reset" (Recommended Replacement Time or Power On Reset) parameters. Thirty-five patients with implanted pacing systems (23 DDDR, 6 VVIR, 5 DDD, 1 VVI, 31 bipolar and 4 unipolar) underwent RF catheter ablation. Prior to ablation, each pacing system underwent measurements of pacing and sensing thresholds, telemetry of intracardiac electrograms and measurement of battery voltage and lead impedance(s). During ablation, pacemaker function was monitored by real-time telemetry, intracardiac electrograms, and surface ECG. Immediately after ablation, each pacing system was reevaluated. Telemetry during RF ablation revealed normal pacing and sensing in 14 (40%) of 35 patients. Refractory period extension with asynchronous pacing and noise mode reversion were seen in 16 (46%) of 35 patients. Rare under- and/or oversensing, reversion to reset parameters, and telemetry "lock up" with inhibition of pacing output was seen in a few patients. After ablation, there were no significant changes in atrial or ventricular pacing or sensing thresholds or measurements of atrial and ventricular lead impedances. We conclude that most permanent pacemakers are not adversely affected by exposure to RF energy during catheter ablation. A variety of pacemaker behaviors may be seen during RF ablation, and a thorough understanding of each pulse generator's potential response(s) to electromagnetic interference is important before undertaking catheter ablation in patients with permanent pacemakers. Careful reevaluation of the patient's pacing system following the procedure is mandatory.
我们通过监测植入式起搏系统在暴露于射频能量之前、期间和之后的功能，研究了在植入永久性起搏器的患者中进行射频导管消融的安全性。植入起搏系统的患者可能需要进行射频消融来治疗各种快速性心律失常。高频电磁场，如射频能量，可能会影响植入的起搏系统，导致输出暂时或永久丧失、感知不足、感知过度、异步起搏或恢复到“重置”（推荐更换时间或开机重置）参数。35例植入起搏系统的患者（23例DDDR、6例VVIR、5例DDD、1例VVI、31例双极和4例单极）接受了射频导管消融。在消融前，对每个起搏系统进行起搏和感知阈值测量、心内电图遥测以及电池电压和导线阻抗测量。在消融期间，通过实时遥测、心内电图和体表心电图监测起搏器功能。消融后立即对每个起搏系统进行重新评估。射频消融期间的遥测显示，35例患者中有14例（40%）起搏和感知正常。35例患者中有16例（46%）出现了异步起搏导致的不应期延长和噪声模式恢复。少数患者出现了罕见的感知不足和/或感知过度、恢复到重置参数以及遥测“锁定”并伴有起搏输出抑制。消融后，心房或心室起搏或感知阈值以及心房和心室导线阻抗测量均无显著变化。我们得出结论，大多数永久性起搏器在导管消融期间暴露于射频能量时不会受到不利影响。在射频消融期间可能会出现多种起搏器行为，在对植入永久性起搏器的患者进行导管消融之前，充分了解每个脉冲发生器对电磁干扰的潜在反应很重要。术后必须对患者的起搏系统进行仔细的重新评估。
