Catheter-induced mechanical trauma to accessory pathways during radiofrequency ablation: incidence, predictors and clinical implications.
Catheter-induced mechanical trauma to accessory pathways during radiofrequency ablation: incidence, predictors and clinical implications.
复制标题
射频消融过程中导管引起的旁路机械损伤：发生率、预测因素和临床意义。
DOI：
10.1016/s0735-1097(98)00643-3
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发表时间：
1999
影响因子：
24
通讯作者：
M. Eldar
中科院分区：
文献类型：
--
作者：
B. Belhassen;S. Viskin;R. Fish;A. Glick;M. Glikson;M. Eldar
目的 评估射频消融过程中非故意导管引起的旁路机械损伤的发生率、预测因素和临床意义。背景有关导管引起的旁路机械损伤的发生率和意义的数据很少。方法对在两个不同机构连续接受射频消融的患者（n = 381）进行密切监测，观察导管操作过程中是否出现旁路机械性阻塞。结果对附件的机械损伤在 37 名 (9.7%) 患者中观察到了通路。根据多变量分析，与这种现象相关的唯一自变量是解剖通路位置（p = 0.0001）。右前间隔 (38.5%) 或右房束通路 (33.3%) 的创伤发生率显着高于所有其余位置的通路 (≤10%) (p < 0.0001)。观察到的传导阻滞持续时间范围分别为 19% 和 35% 的患者≤1 分钟至 >30 分钟。在机械性阻滞部位“立即”应用射频脉冲（发生后不到 1 分钟）与 78% 的长期随访成功率相关。相比之下，在阻塞发生后 30 分钟才提供脉冲（“延迟脉冲”）的患者的长期成功率为 25%。最后，24% 的患者持续性创伤引起的传导阻滞导致消融手术中止。 结论 旁路创伤比以前认识到的更为常见，并且经常导致消融手术的延长或中止以及较低的成功率。旁路导管损伤的唯一独立预测因子是通路位置。
OBJECTIVESTo evaluate the incidence, predictors and clinical implications of nonintentionally catheter-induced mechanical trauma to accessory pathways during radiofrequency ablation procedures.BACKGROUNDData on the incidence and significance of catheter-induced trauma to accessory pathways are scarce.METHODSConsecutive patients (n = 381) undergoing radiofrequency ablation of accessory pathways at two different institutions were closely monitored for appearance of mechanical block of accessory pathways during catheter manipulation.RESULTSMechanical trauma to accessory pathways was observed in 37 (9.7%) patients. According to a multivariate analysis, the only independent variable associated with this phenomenon was the anatomical pathway location (p = 0.0001). The incidence of trauma of either right anteroseptal (38.5%) or right atriofascicular pathways (33.3%) was significantly greater than that of pathways (≤10%) at all remaining locations (p < 0.0001). The duration of conduction block observed ranged from ≤1 min to >30 min in 19% and 35% of patients, respectively. “Immediate” application of radiofrequency pulses at sites of mechanical block (<1 min after occurrence) was associated with a 78% long-term success rate at follow-up. This contrasted with a 25% long-term success rate in patients in whom pulses were delivered 30 min after occurrence of block (“delayed pulses”). Finally, in 24% of patients persistent trauma-induced conduction block led to discontinuation of the ablation procedure.CONCLUSIONSTrauma to accessory pathways is more common than previously recognized and frequently results in prolongation or discontinuation of the ablation procedure and in lower success rates. The only independent predictor of catheter-trauma to accessory pathways is the pathway location.
影响因子：
158.5
作者：
JACKMAN, WM;WANG, XZ;LAZZARA, R
通讯作者：
LAZZARA, R