Hsieh M H, Chen S A, Tai C T, Yu W C, Chen Y J, Chang M S
Division of Cardiology, Department of Medicine, National Yang-Ming University, School of Medicine, and Veterans General Hospital-Taipei, Taiwan.
Circulation. 1998 Nov 24;98(21):2296-300. doi: 10.1161/01.cir.98.21.2296.
The presence of junctional rhythm has been considered to be a sensitive marker of successful slow-pathway ablation. However, in rare cases, junctional rhythm was absent despite multiple radiofrequency applications delivered over a large area in the Koch's triangle, and successful ablation was achieved in the absence of a junctional rhythm.
This study included 353 patients with AV nodal reentrant tachycardia (143 men and 210 women; mean age, 50+/-17 years) who underwent catheter ablation of the slow pathway. Combined anatomic and electrogram approaches were used to guide ablation. Inducibility of AV nodal reentrant tachycardia was assessed after each application of radiofrequency energy. Successful sites were located in the posterior area in 18 (90%) of 20 patients without junctional rhythm during slow-pathway ablation compared with 200 (60%) of 333 patients with junctional rhythm (P<0.001). The fast-slow form of tachycardia was more common in patients without than in those with junctional rhythm (30% versus 3%; P=0.001). At the successful ablation sites, patients with junctional rhythm had a higher incidence of a multicomponent or slow-pathway potential (51% versus 10%; P<0.001), a longer duration of the atrial electrogram (64+/-8 versus 50+/-9 ms; P=0.04), and a smaller atrial/ventricular electrogram amplitude ratio (0.29+/-0.18 versus 0.65+/-0.27; P<0. 001) than those without junctional rhythm. Mean temperatures at successful sites (56+/-6 degreesC versus 58+/-9 degreesC; P=0.57) and incidence of transient AV block (2% versus 0%; P=0.86) were similar between patients with and without junctional rhythms. By multivariate analysis, location of ablation sites, atrial/ventricular electrogram amplitude ratio, absence of a multicomponent or slow-pathway potential, and occurrence of the fast-slow form of tachycardia were independent predictors of the absence of a junctional rhythm during successful slow-pathway ablation.
In some rare cases, successful slow-pathway ablation is possible in the absence of a junctional rhythm.
交界性心律的出现一直被认为是慢径路消融成功的敏感标志。然而，在罕见情况下，尽管在 Koch 三角的大片区域进行了多次射频消融，但仍未出现交界性心律，且在无交界性心律的情况下成功完成了消融。
本研究纳入了 353 例房室结折返性心动过速患者（男性 143 例，女性 210 例；平均年龄 50±17 岁），这些患者接受了慢径路导管消融。采用解剖与电图相结合的方法指导消融。每次施加射频能量后评估房室结折返性心动过速的诱发情况。在慢径路消融过程中，20 例无交界性心律的患者中有 18 例（90%）成功消融部位位于后方区域，而 333 例有交界性心律的患者中有 200 例（60%）成功消融部位位于后方区域（P<0.001）。无交界性心律的患者中快慢型心动过速比有交界性心律的患者更常见（30% 对 3%；P=0.001）。在成功消融部位，有交界性心律的患者多成分或慢径路电位的发生率更高（51% 对 10%；P<0.001），心房电图持续时间更长（64±8 对 50±9 毫秒；P=0.04），且心房/心室电图振幅比更小（0.29±0.18 对 0.65±0.27；P<0.001）。有交界性心律和无交界性心律的患者成功消融部位的平均温度（56±6℃对 58±9℃；P=0.57）及短暂性房室传导阻滞的发生率（2% 对 0%；P=0.86）相似。多因素分析显示，消融部位的位置、心房/心室电图振幅比、无多成分或慢径路电位以及快慢型心动过速的发生是成功慢径路消融时无交界性心律的独立预测因素。
在一些罕见情况下，无交界性心律时慢径路消融仍有可能成功。
