Limitations of adenosine in assessing the efficacy of radiofrequency catheter ablation of accessory pathways.
Limitations of adenosine in assessing the efficacy of radiofrequency catheter ablation of accessory pathways.
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腺苷在评估旁路射频导管消融疗效中的局限性。
DOI：
10.1016/0002-9149(94)90880-x
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发表时间：
1994
期刊：
影响因子：
--
通讯作者：
Lerman,BB
中科院分区：
文献类型：
--
作者：
Engelstein,ED;Wilber,D;Wadas,M;Stein,KM;Lippman,N;Lerman,BB
腺苷已被证明可以通过在心房和心室起搏期间产生短暂的房室 (AV) 传导阻滞来可靠地确认旁路导管消融的成功。这是由于旁路传导对腺苷不敏感（具有递减传导特性的旁路很少例外）。然而，204 名连续接受旁路消融（如腺苷诱导的短暂性房室传导阻滞所示）的连续患者中，有 4 名患者出现复发性房室往复性心动过速，涉及第二条先前不明显的旁路。在每种情况下，第二旁路都位于与原始通路不同的部位。没有通路表现出递减的顺行或逆行传导特性。在 2 名患者中，腺苷最初未显示第二个隐藏旁路的存在，因为旁路的不应期长于用于评估心室传导的起搏周期长度。只有当输注异丙肾上腺素缩短第二条旁路的不应期时，腺苷才能在后续电生理学研究中揭示该通路的存在。在另一名患者中，非递减旁路被证明对腺苷敏感。在剩下的患者中，第二个旁路可能在最初的研究过程中受到短暂损伤，从而模拟了腺苷敏感性。因此，得出结论：（1）腺苷是一种高度但不完全有效的即时评估旁路导管消融疗效的方法； (2) 腺苷给药期间必须同时输注异丙肾上腺素，以识别不应期延长的旁路通路的存在； (3) 消融后用腺苷评估旁路传导的存在最好应在尽可能最长的、起搏的周期长度下进行。
Adenosine has been shown to reliably confirm the success of accessory pathway catheter ablation by producing transient atrioventricular (AV) block during atrial and ventricular pacing. This is due to the insensitivity of accessory pathway conduction to adenosine (with the rare exception of accessory pathways with decremental conduction properties). However, 4 of 204 consecutive patients who underwent successful accessory pathway ablation (as shown by adenosine-induced transient AV block) had recurrent AV reciprocating tachycardia involving a second, previously nonmanifest accessory pathway. In each case, the second accessory pathway was localized to a site disparate from the original pathway. No pathway showed decremental anterograde or retrograde conduction properties. In 2 patients, adenosine initially did not show the presence of the second concealed accessory pathway, because the refractory period of the accessory pathway was longer than the pacing cycle length used to assess ventriculoatrial conduction. Only when the refractory period of this second accessory pathway was shortened by infusion of isoproterenol did adenosine reveal the presence of the pathway during follow-up electrophysiologic study. In another patient, a non-decremental accessory pathway was shown to be sensitive to adenosine. In the remaining patient, the second accessory pathway may have been transiently injured during the initial study, thereby simulating adenosine sensitivity. Therefore, it is concluded that (1) adenosine is a highly, but not completely, effective method for immediately assessing the efficacy of accessory pathway catheter ablation; (2) concomitant infusion of isoproterenol during adenosine administration is necessary to recognize the presence of accessory pathways with prolonged refractory periods; and (3) assessment of the presence of accessory pathway conduction with adenosine after ablation should preferably be performed at the longest possible, paced cycle length.
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影响因子：
2.8
作者：
KLEIN, GJ;GULAMHUSEIN, SS
通讯作者：
GULAMHUSEIN, SS
影响因子：
158.5
作者：
CALKINS, H;SOUSA, J;MORADY, F
通讯作者：
MORADY, F
DOI：
10.1016/0735-1097(92)90622-t
发表时间：
1992-06-01
影响因子：
24
作者：
LANGBERG, JJ;CALKINS, H;MORADY, F
通讯作者：
MORADY, F
影响因子：
39.3
作者：
B. Perrot;J. Clozel;G. Faivre
通讯作者：
G. Faivre
从右心室心尖期早搏的心室-心房传导时间定位沃尔夫-帕金森-怀特综合征的辅助通路
DOI：
--
发表时间：
1983
期刊：
Pacing and clinical electrophysiology : PACE
影响因子：
--
作者：
Jim Weiss;P. Brugada;D. Roy;F. Bär;H. Wellens
通讯作者：
H. Wellens