Jayaprakash S, Sparks P B, Vohra J
Department of Cardiology, Royal Melbourne Hospital, Vic.
Aust N Z J Med. 1997 Aug;27(4):391-7. doi: 10.1111/j.1445-5994.1997.tb02197.x.
Inappropriate sinus tachycardia (IST) is a rare form of supraventricular arrhythmia. It can cause disabling symptoms and may be refractory to medical treatment. In symptomatic drug refractory patients, sinus node excision or total ablation of the sinus node with permanent pacemaker implantation was the only therapeutic option. Recently, radiofrequency (RF) modification of the sinus node has been reported to be an effective treatment for this condition.
To present our experience with sinus node modification using RF energy in the management of IST.
Between 1989 to 1996 three patients (two females and one male), aged 28-36 years were diagnosed with symptomatic IST. All had failed multiple drugs and hence underwent sinus node modification using RF. In the first two patients, the site of RF application was guided by anatomical landmarks using fluoroscopy to localise the presumed most superior portion of the crista terminalis and also the earliest site of atrial activation. In the third patient, a 20 pole electrode catheter was used to map the crista terminalis and guide the ablation. Success was defined by 20-30% reduction in the heart rate with normal atrial activation sequence after ablation.
The three patients described here had IST by clinical, electrocardiographic and electrophysiological criteria and were refractory to multiple antiarrhythmic drugs. The number of RF applications were 11, 15, and three applied at the site of earliest atrial activation for the control of heart rates. Patient 3 had a early recurrence at one month and underwent repeat sinus node modification (five RF applications). All three patients who underwent RF modification of the sinus node had a successful outcome. The procedure was uncomplicated and the patients remain asymptomatic during follow up (20, 12 and three months) with satisfactory control of heart rate, although one patient requires atenolol which was previously ineffective.
RF modification of the sinus node is feasible and effective for IST, and should be the treatment of choice in patients refractory to medical therapy.
不适当窦性心动过速（IST）是一种罕见的室上性心律失常形式。它可导致使人丧失能力的症状，且可能对药物治疗无效。对于有症状且药物难治的患者，窦房结切除或窦房结完全消融并植入永久起搏器是唯一的治疗选择。最近，有报道称射频（RF）改良窦房结是治疗这种疾病的有效方法。
介绍我们使用射频能量改良窦房结治疗IST的经验。
1989年至1996年间，3例患者（2例女性，1例男性），年龄28 - 36岁，被诊断为有症状的IST。所有患者多种药物治疗均失败，因此接受了射频改良窦房结治疗。在前两例患者中，射频应用部位通过荧光镜下的解剖标志来引导，以定位界嵴的推测最上部以及心房激动最早部位。在第三例患者中，使用一根20极电极导管标测界嵴并指导消融。成功的定义为消融后心率降低20% - 30%且心房激动顺序正常。
这里描述的3例患者根据临床、心电图和电生理标准诊断为IST，对多种抗心律失常药物难治。在最早心房激动部位进行的射频应用次数分别为11次、15次和3次以控制心率。患者3在1个月时早期复发，接受了重复窦房结改良（5次射频应用）。所有3例接受射频改良窦房结的患者均取得成功结果。该手术无并发症，患者在随访期间（20个月、12个月和3个月）仍无症状，心率控制良好，尽管1例患者需要使用之前无效的阿替洛尔。
射频改良窦房结对IST是可行且有效的，应成为药物治疗难治患者的首选治疗方法。
