DIAGNOSIS AND CURE OF THE WOLFF-PARKINSON-WHITE SYNDROME OR PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIAS DURING A SINGLE ELECTROPHYSIOLOGIC TEST
DIAGNOSIS AND CURE OF THE WOLFF-PARKINSON-WHITE SYNDROME OR PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIAS DURING A SINGLE ELECTROPHYSIOLOGIC TEST
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DOI：
10.1056/nejm199106063242302
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发表时间：
1991-06-06
影响因子：
158.5
通讯作者：
MORADY, F
中科院分区：
文献类型：
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作者：
CALKINS, H;SOUSA, J;MORADY, F
背景 我们进行了这项研究，以确定一个简短的治疗方法的可行性，沃尔夫-帕金森-白色综合征或阵发性室上性心动过速，其中的诊断是建立和射频消融进行在一个单一的电生理测试。 106例连续患者被转诊治疗记录在案的症状性阵发性室上性心动过速（66例患者）或沃尔夫-帕金森-白色综合征（40例患者）。 所有患者均同意接受诊断性电生理检查和射频电流导管消融。 以前没有病人做过这样的检查。 在66例阵发性室上性心动过速患者中，发现其机制为房室结折返46例（70%）（典型44例，非典型2例），房室折返性心动过速涉及隐匿性旁路16例（24%），房性心动过速2例（3%），非诱导性阵发性室上性心动过速2例（3%）。 62例阵发性室上性心动过速患者中有57例（92%）尝试消融，40例Wolff-Parkinson-白色综合征患者中有37例（93%）获得了成功的长期结局。 唯一的并发症是一例冠状动脉左回旋支闭塞，导致急性心肌梗死，一例完全房室传导阻滞。 电生理程序的平均（+/- SD）持续时间为114 +/- 55 min。 在一次电生理检查中诊断和治疗阵发性室上性心动过速或预白色综合征是可行和实用的，具有良好的风险效益比。 这种简化的治疗方法可以消除对系列电药理学测试，长期药物治疗，抗心动过速起搏器和手术消融的需要。
Background. We conducted this study to determine the feasibility of an abbreviated therapeutic approach to the Wolff-Parkinson-White syndrome or paroxysmal supraventricular tachycardia, in which the diagnosis is established and radiofrequency ablation carried out during a single electrophysiologic test.Methods. One hundred six consecutive patients were referred for the management of documented, symptomatic paroxysmal supraventricular tachycardias (66 patients) or the Wolff-Parkinson-White syndrome (40 patients). All agreed to undergo a diagnostic electrophysiologic test and catheter ablation with radiofrequency current. No patient had had such a test previously.Results. Among the 66 patients with paroxysmal supraventricular tachycardias, the mechanism was found to be atrioventricular nodal reentry in 46 (70 percent) (typical in 44 and atypical in 2), atrioventricular reciprocating tachycardia involving a concealed accessory pathway in 16 (24 percent), atrial tachycardia in 2 (3 percent), and noninducible paroxysmal supraventricular tachycardia in 2 (3 percent). A successful long-term outcome was achieved in 57 of 62 patients (92 percent) with paroxysmal supraventricular tachycardia in whom ablation was attempted and in 37 of 40 patients (93 percent) with the Wolff-Parkinson-White syndrome. The only complications were one instance of occlusion of the left circumflex coronary artery, leading to acute myocardial infarction, and one instance of complete atrioventricular block. The mean (+/- SD) duration of the electrophysiologic procedures was 114 +/- 55 minutes.Conclusions. The diagnosis and cure of paroxysmal supraventricular tachycardia or the Wolff-Parkinson-White syndrome during a single electrophysiologic test are feasible and practical and have a favorable risk-benefit ratio. This abbreviated therapeutic approach may eliminate the need for serial electropharmacologic testing, long-term drug therapy, antitachycardia pacemakers, and surgical ablation.