Tai C T, Chen S A, Chiang C E, Wu T J, Cheng C C, Chiou C W, Lee S H, Ueng K C, Chang M S
Department of Medicine, National Yang-Ming University, Taiwan, R.O.C.
Eur Heart J. 1997 Jan;18(1):132-9. doi: 10.1093/oxfordjournals.eurheartj.a015095.
Information about accessory pathways conducting only in the antegrade direction is limited. The purposes of the present study were to prospectively investigate the clinical features, electrophysiological characteristics, effects of radiofrequency catheter ablation and recurrent atrial fibrillation after successful ablation in patients with accessory pathways conducting only in the antegrade direction, and to compare them with those who had pathways capable of bidirectional conduction in a consecutive series of 759 patients. Electrophysiological studies and radiofrequency catheter ablation were performed in 33 study patients with antegrade-only accessory pathways and in 377 patients with bidirectional accessory pathways for comparison. The patients with accessory pathways conducting only in the antegrade direction were older (47 +/- 16 vs 40 +/- 16 years, P = 0.037) and had a higher incidence of atrial fibrillation (100% vs 27.1%, P < 0.001) as well as related syncope (33.3% vs 10.1%, P = 0.001). The study patients also had more accessory pathways located in the posterior septum and a higher incidence of retrograde atrioventricular nodal conduction. The biophysical variables, success and complication rates of radiofrequency ablation were similar in both groups. During the follow-up period of 32 +/- 12 months, symptomatic atrial fibrillation after successful ablation did not recur in 79% and 81% of patients with unidirectional and bidirectional accessory pathways, respectively. Furthermore, old age and cardiovascular diseases were independent predictors of recurrent atrial fibrillation after radiofrequency ablation. In conclusion, this study showed that atrial fibrillation with preexcitation was the usual presentation in patients who had symptomatic Wolff-Parkinson White syndrome with an antegrade-only accessory pathway, and might be related to antegrade conduction of the accessory pathway. Therefore elimination of antegrade-only and bidirectional pathways by radiofrequency ablation could prevent the recurrence of symptomatic atrial fibrillation in younger patients without cardiac disease.
关于仅能前传的房室旁道的信息有限。本研究的目的是前瞻性地调查仅能前传的房室旁道患者的临床特征、电生理特性、射频导管消融的效果以及成功消融后房颤复发情况，并将其与759例连续患者中具有双向传导旁道的患者进行比较。对33例仅能前传旁道的研究患者和377例双向旁道患者进行了电生理研究和射频导管消融以作比较。仅能前传旁道的患者年龄较大（47±16岁对40±16岁，P = 0.037），房颤发生率较高（100%对27.1%，P < 0.001）以及相关晕厥发生率较高（33.3%对10.1%，P = 0.001）。研究患者也有更多位于后间隔的旁道以及较高的房室结逆向传导发生率。两组的射频消融生物物理变量、成功率和并发症发生率相似。在32±12个月的随访期内，单向和双向旁道患者成功消融后有症状房颤复发率分别为79%和81%。此外，年龄较大和心血管疾病是射频消融后房颤复发的独立预测因素。总之，本研究表明，有症状的预激综合征且仅有前传旁道的患者通常表现为预激性房颤，可能与旁道的前传有关。因此，通过射频消融消除仅能前传和双向旁道可预防无心脏病的年轻患者有症状房颤的复发。
