Caires G, Adragão P, Bragança G, Parreira L, Morgado F, Bonhorst D, Seabra-Gomes R
Serviço de Cardiologia, Hospital de Santa Cruz, Carnaxide.
Rev Port Cardiol. 1997 Mar;16(3):251-7, 241.
The aim of this paper was to evaluate our results of radiofrequency catheter ablation (RFCA) of accessory pathways in patients with WPW syndrome.
We studied 100 consecutive patients with WPW syndrome, 52 men and 48 women, mean age 37 +/- 15 years who underwent RFCA. All patients were symptomatic, with documented episodes of supraventricular tachycardia and 9% of patients had underlying cardiac disease.
The RFCA was performed without antiarrhythmic drugs in the same session of the electrophysiologic diagnosis. The location of the accessory pathway site was obtained by catheter mapping, based on the premature and/or the presence of Kent potentials. According to the location of the accessory pathway, the ablation catheter was introduced either by the femoral vein or artery with mapping of the tricuspid or mitral ring. In the first cases performed energy application was manually controlled and thereafter was temperature guided with an upper temperature limit of 70 degrees C. We considered primary success criteria the disappearance of the delta wave in the surface ECG and the absence of ventricular preexcitation under atrial pacing and after adenosine injection. Clinical success was defined as the absence of clinical recurrence of tachycardia during the follow-up period.
The primary success rate achieved was 88%; 91% in the left free wall pathways, 100% in the right free wall and 85% in the septal pathways (antero-septal-83%; right postero-septal-76.5%; left postero-septal-92%). A second ablation procedure was performed in seven of the twelve patients with primary unsuccess obtaining a final success rate of 93% (left free wall-94.5%; septal pathways-91.6%). After a mean follow-up period of 8 +/- 7 months clinical recurrence occurred in 9% (eight patients), five of which are under anti-arrhythmic therapy (62.5%). Clinical success rate at the end of the follow-up period was 88%.
In our experience RFCA has shown to be safe and with a high success rate in patients with symptomatic pre-excitation. In this group of patients it was an effective therapy.
本文旨在评估我们对预激综合征（WPW）患者行射频导管消融术（RFCA）的结果。
我们研究了100例连续的WPW综合征患者，其中男性52例，女性48例，平均年龄37±15岁，均接受了RFCA。所有患者均有症状，有记录的室上性心动过速发作，9%的患者有潜在心脏病。
在电生理诊断的同一时段，未使用抗心律失常药物进行RFCA。通过导管标测确定旁路部位，基于早搏和/或肯特电位的存在。根据旁路的位置，通过股静脉或动脉插入消融导管，对三尖瓣或二尖瓣环进行标测。在最初的病例中，能量应用是手动控制的，此后由温度引导，温度上限为70℃。我们将体表心电图δ波消失以及心房起搏和注射腺苷后无室性预激作为主要成功标准。临床成功定义为随访期间心动过速无临床复发。
主要成功率为88%；左游离壁旁路为91%，右游离壁为100%，间隔旁路为85%（前间隔-83%；右后间隔-76.5%；左后间隔-92%）。12例初次未成功的患者中有7例进行了第二次消融手术，最终成功率为93%（左游离壁-94.5%；间隔旁路-91.6%）。平均随访8±7个月后，9%（8例患者）出现临床复发，其中5例接受抗心律失常治疗（62.5%）。随访期末临床成功率为88%。
根据我们的经验，RFCA对有症状预激患者显示出安全且成功率高。在这组患者中，它是一种有效的治疗方法。
