Transvascular argon laser ablation of atrioventricular conduction in dogs: feasibility and morphological results.
Transvascular argon laser ablation of atrioventricular conduction in dogs: feasibility and morphological results.
复制标题
狗房室传导的经血管氩激光消融：可行性和形态学结果。
DOI：
10.1111/j.1540-8159.1989.tb02668.x
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发表时间：
1989
期刊：
影响因子：
--
通讯作者：
Normann,SJ
中科院分区：
文献类型：
--
作者：
Curtis,AB;Abela,GS;Griffin,JC;Hill,JA;Normann,SJ
本研究的目的是消融房室（AV）传导的狗与氩激光使用经血管的方法。将6只犬麻醉并进行右胸廓切开术和心房切开术。使用含有400 u二氧化硅纤维的双极#7 French管腔导管标测AV连接区。当获得稳定的His偏转时，从导管的端部挤出二氧化硅纤维，并在3.0-4.5瓦下递送氩激光辐射长达20 s。在6只狗中的5只中，在3至15次激光后成功地建立了完全心脏传导阻滞。一只狗的连续希氏束电图显示，在完全希氏束下阻滞发展之前，HV间期逐渐延长。5只完全性心脏传导阻滞犬的平均R-R间期从435 ± 56 ms增加到1216 ± 197 ms（P < 0.001），QRS时限从78 ± 26 ms增加到91 ± 19 ms（P = ns）。大体检查显示三尖瓣环上方心房内有多个1-2 mm 2的弹坑。并发症包括主动脉根部穿孔和小室间隔缺损各一例。这些病变非常小，发生病变的任何动物均未出现血流动力学损害，病变本身仅在仔细的尸检中检测到。组织学显示两种类型的损伤涉及传导消融。一个是组织直接汽化，导致楔形切口，另一个是在激光部位形成血肿和热坏死，几乎没有组织汽化的证据。虽然导管修改是必要的，以避免穿孔，这项研究表明，消融传导可以成功地完成使用氩激光。
The purpose of this study was to ablate atrioventricular (AV) conduction in dogs with an argon laser using a transvascular approach. Six dogs were anesthetized and underwent a right thoracotomy and atriotomy. A bipolar #7 French lumen catheter containing a 400 u silica fiber was used to map the region of the AV junction. When a stable His deflection was obtained, the silica fiber was extruded from the end 0f the catheter and argon laser radiation was delivered for up to 20 s at 3.0–4.5 watts. In five of six dogs, complete heart block was successfully created after 3 to 15 lasings. A continuous His bundle electrogram in one dog showed gradual prolongation of the HV interval before the development of complete infrahisian block. The mean R‐R intervals in the five dogs with complete heart block increased from 435 ± 56 ms to 1216 ± 197 ms (P < 0.001], and the QRS duration increased from 78 ± 26 ms to 91 ± 19 ms (P = ns). Gross inspection showed multiple 1–2 mm2craters in the atria just above the tricuspid valve ring. Complications included one instance each of aortic root perforation and creation of a small ventricular septal defect. These lesions were so small that there was no hemodynamic compromise in either animal in which they occurred and the lesions themselves were only detected on careful postmortem examination. Histology revealed two patterns of injury involved in conduction ablation. One was direct vaporizaton of tissue resulting in a wedge shaped incision and the other was formation of a hematoma and thermal necrosis at the lasing site with little evidence of tissue vaporizotion. Although catheter modifications are necessary to avoid perforation, this study demonstrates that ablation of conduction can be successfully accomplished using an argon laser.