Lai L P, Lin J L, Chen T F, Ko W C, Lien W P
Department of Internal Medicine, National Taiwan University Hospital.
Pacing Clin Electrophysiol. 1998 Feb;21(2):367-74. doi: 10.1111/j.1540-8159.1998.tb00060.x.
Atrial tachycardia, with its focus near the apex of Koch's triangle, may carry a potential risk of atrioventricular block during radiofrequency catheter ablation. The efficacy and safety of this procedure have never been addressed. The characteristics and catheter ablation results are reported for six patients with atrial tachycardia near the apex of Koch's triangle. All six patients were female aged 49.6 +/- 9.3 years (range 39-63). Organic heart disease was present in 3 (50%) of the 6 patients. The P wave in surface ECG had a mean axis of -28 degrees (range -90 degrees - +30 degrees) in the frontal plane. The catheter ablation was guided by activation sequence mapping. The energy was titrated from low power level. Atrial overdrive pacing was used to monitor the atrioventricular conduction should accelerated junctional rhythm occur. At the final successful ablation site, the local atrial activation was 41.8 +/- 9.1 ms before the P wave and His-bundle potential was present in 5 of the 6 patients. All patients had their atrial tachycardia eliminated without recurrence or heart block during a follow-up period of 17.7 +/- 8.5 months (range 6-30). In conclusion, atrial tachycardia near the apex of Koch's triangle has distinct clinical and electrophysiological features. Radiofrequency catheter ablation can be performed effectively. However, extreme care must be taken to prevent inadvertent atrioventricular block. Titrated energy application and continuous monitoring of atrioventricular conduction are mandatory.
起源于科赫三角顶点附近的房性心动过速在射频导管消融过程中可能存在房室传导阻滞的潜在风险。该手术的有效性和安全性尚未得到探讨。本文报道了6例起源于科赫三角顶点附近的房性心动过速患者的特征及导管消融结果。所有6例患者均为女性，年龄49.6±9.3岁（范围39 - 63岁）。6例患者中有3例（50%）存在器质性心脏病。体表心电图P波在额面平均电轴为 - 28度（范围 - 90度至 + 30度）。导管消融采用激动顺序标测指导。能量从低功率水平开始滴定。若出现加速性交界性心律，采用心房超速起搏监测房室传导。在最终成功的消融部位，局部心房激动较P波提前41.8±9.1毫秒，6例患者中有5例出现希氏束电位。所有患者在17.7±8.5个月（范围6 - 30个月）的随访期内心房心动过速均消除，无复发或心脏阻滞。总之，起源于科赫三角顶点附近的房性心动过速具有独特的临床和电生理特征。射频导管消融可以有效进行。然而，必须格外小心以防止意外的房室传导阻滞。必须采用滴定能量应用并持续监测房室传导。
