Cryosurgical treatment of atrioventricular node reentrant tachycardia.
Cryosurgical treatment of atrioventricular node reentrant tachycardia.
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房室结折返性心动过速的冷冻手术治疗。
DOI：
10.1161/01.cir.76.6.1329
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发表时间：
1987
期刊：
影响因子：
37.8
通讯作者：
Cain,ME
中科院分区：
文献类型：
--
作者：
Cox,JL;Holman,WL;Cain,ME
阵发性室上性心动过速最常见的原因是房室结内折返性心动过速。尽管希氏束消融治疗房室结折返性心动过速患者对药物治疗难以奏效，但不良的后遗症包括完全性心脏传导阻滞和永久起搏器的必要性。为了避免这一限制，我们开发了一种离散的冷冻手术程序，它可以在不阻断房室传导的情况下中断导致房室结折返性心动过速的折返电路。在实验动物中首次确定了这种方法的有益效果后，我们对8名房室结折返性心动过速患者进行了这一手术。术前、术中、术后均进行电生理检查。在常温体外循环和持续监测房室传导的恒速心房起搏条件下，在右下房间隔Koch三角周围预定位置放置9个3 mm冷冻室(-60℃，2min)。术后，每个患者都有一条房室结传导曲线。在长达5年的随访中，临床上没有患者发生过房室结折返性心动过速或房室结折返性心动过速。冷冻手术对房室结文克巴赫发生时的AH或HV间期或起搏周期长度无不良影响。基于这些结果，这种根治性手术为难以治疗的房室结折返性心动过速患者提供了希望。
Paroxysmal supraventricular tachycardia most commonly arises from reentry within the atrioventricular (AV) node. Although ablation of the His bundle has gained popularity for treating patients with AV node reentrant tachycardia refractory to medical therapy, undesirable sequelae include complete heart block and the necessity for a permanent pacemaker. To obviate this limitation, we have developed a discrete cryosurgical procedure that interrupts the reentrant circuit responsible for AV node reentrant tachycardia without blocking AV conduction. After first characterizing the salutary effects of this approach in experimental animals, we performed this procedure in eight patients with AV node reentrant tachycardia. Preoperative, intraoperative, and postoperative electrophysiologic studies were performed in each patient. Under conditions of normothermic cardiopulmonary bypass and during atrial pacing at a constant rate with continuous monitoring of AV conduction, nine separate 3 mm cryolesions (-60 degrees C for 2 min) were placed at predetermined sites around the triangle of Koch in the lower right atrial septum. Postoperatively, each patient had a single AV node conduction curve. No patient had AV node reentrant tachycardia induced or has experienced AV node reentrant tachycardia clinically during a follow-up of up to 5 years. The cryosurgical procedure had no detrimental effects on the AH or HV interval or on the paced cycle length at which AV node Wenckebach occurred. Based on these results, this curative operation offers promise for patients with AV node reentrant tachycardia that is refractory to medical treatment.