Manolis A G, Katsivas A G, Lazaris E E, Vassilopoulos C V, Louvros N E
2nd Cardiology Department, Hellenic Red Cross Hospital, Athens, Greece.
J Interv Card Electrophysiol. 1998 Mar;2(1):71-6. doi: 10.1023/a:1009721008761.
In patients with drug refractory atrial tachyarrhythmias and previous failed attempts of ablation of the arrhythmia substrate, radiofrequency (RF) modulation or ablation of the atrioventricular (AV) junction is an alternative procedure.
Of this study was to assess the efficacy and long term results of RF AV junction ablation in conjunction with permanent pacemaker implantation, in the management of patients with drug resistant atrial tachyarrhythmias.
Between 4/92 and 1/97, 46 patients (30 male, 16 female, 67 +/- 12 years) underwent RF AV junction ablation because of paroxysmal atrial fibrillation (24 patients), chronic atrial fibrillation (13 patients), atrial flutter (5 patients) and atrial tachycardia (4 patients). The underlying heart disease was dilated cardiomyopathy (16), ischemic heart disease (9), hypertensive heart disease (6), hypertrophic cardiomyopathy (3), atrial septal defect (2) and non structural heart disease (10). The duration of symptoms was 6.4 +/- 3.5 years at a maximal heart rate 169 +/- 24 bpm. The hospital admissions in the last 12 months were 8.2 +/- 3 per patient. The failed antiarrhythmic drugs were 3.5 +/- 2.1. The functional NYHA class was 2.7 +/- 0.6. Patients with atrial flutter and atrial tachycardia had previous failed attempts of RF ablation of the arrhythmia substrate. Thirty patients had a compromised left ventricular systolic function with LVEF below 50% (mean 34 +/- 9%). AV junction ablation was achieved in all patients after 4 +/- 2.5 RF applications. Post ablation, the selected pacing mode was DDD-R for the 33 patients with paroxysmal atrial tachyarrhythmias and VVI-R for the 13 pts with chronic atrial fibrillation. The dual chamber pacemakers implanted had the option of automatic mode switch.
During the follow-up period of 28 +/- 13 months (6-47), AV conduction recovered in 1 patient. Antiarrhythmic treatment was necessary in only 7 patients. Post ablation the new functional NYHA class was 1.4 +/- 0.8 (p < 0.001). Post ablation hospital admissions, including ordinary pacemaker follow-up visits, were 4 +/- 1 per patient per year (p < 0.001). Six months after the procedure the LVEF of the study population was increased from 42 +/- 16% to 50 +/- 14% (p = NS). In the 30 patients with heart failure the LVEF was significantly increased to 46 +/- 8% (p < 0.05). Symptomatic relief or significant improvement was observed in all patients as showed by the answers given in a customized questionnaire before and after the procedure.
In patients with drug refractory atrial tachyarrhythmias, RF AV junction ablation and permanent pacemaker implantation is an alternative therapy with excellent long term results in terms of arrhythmia control, ventricular performance and quality of life.
对于药物难治性房性快速心律失常且既往心律失常基质消融术失败的患者，射频（RF）调制或房室（AV）结消融是一种替代方法。
本研究旨在评估射频房室结消融联合永久起搏器植入术治疗药物抵抗性房性快速心律失常患者的疗效和长期结果。
在1992年4月至1997年1月期间，46例患者（30例男性，16例女性，67±12岁）因阵发性心房颤动（24例）、慢性心房颤动（13例）、心房扑动（5例）和房性心动过速（4例）接受了射频房室结消融。基础心脏病为扩张型心肌病（16例）、缺血性心脏病（9例）、高血压性心脏病（6例）、肥厚型心肌病（3例）、房间隔缺损（2例）和无结构性心脏病（10例）。症状持续时间为6.4±3.5年，最大心率为169±24次/分。过去12个月的住院次数为每位患者8.2±3次。抗心律失常药物治疗失败次数为3.5±2.1次。纽约心脏协会（NYHA）功能分级为2.7±0.6级。心房扑动和房性心动过速患者既往心律失常基质的射频消融术失败。30例患者左心室收缩功能受损，左心室射血分数（LVEF）低于50%（平均34±9%）。所有患者在4±2.5次射频应用后均成功实现房室结消融。消融后，33例阵发性房性快速心律失常患者选择DDD-R起搏模式，13例慢性心房颤动患者选择VVI-R起搏模式。植入的双腔起搏器具有自动模式切换功能。
在28±13个月（6 - 47个月）的随访期内，1例患者房室传导恢复。仅7例患者需要抗心律失常治疗。消融后新的NYHA功能分级为1.4±0.8（p < 0.001）。消融后包括普通起搏器随访在内的每年住院次数为每位患者4±1次（p < 0.001）。术后6个月，研究人群的LVEF从42±16%增加到50±14%（p = 无显著性差异）。在30例心力衰竭患者中，LVEF显著增加至46±8%（p < 0.05）。根据术前和术后定制问卷的回答显示，所有患者均有症状缓解或显著改善。
对于药物难治性房性快速心律失常患者，射频房室结消融和永久起搏器植入是一种替代疗法，在心律失常控制、心室功能和生活质量方面具有出色的长期效果。
