RECURRENCE OF CONDUCTION IN ACCESSORY ATRIOVENTRICULAR CONNECTIONS AFTER INITIALLY SUCCESSFUL RADIOFREQUENCY CATHETER ABLATION
RECURRENCE OF CONDUCTION IN ACCESSORY ATRIOVENTRICULAR CONNECTIONS AFTER INITIALLY SUCCESSFUL RADIOFREQUENCY CATHETER ABLATION
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DOI：
10.1016/0735-1097(92)90622-t
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发表时间：
1992-06-01
影响因子：
24
通讯作者：
MORADY, F
中科院分区：
文献类型：
--
作者：
LANGBERG, JJ;CALKINS, H;MORADY, F
本研究的目的是描述首次成功射频导管消融后旁路复发的发生率和临床特征，并确定与复发相关的变量。使用带有大（长4 mm）远端电极的7 F可偏转头端导管进行射频消融。左侧旁路通过左心室进入，右侧旁路通过右心房进入。如果患者1）最初手术成功，定义为消融后立即没有旁路传导，2）接受了3个月的随访电生理检查或记录了旁路传导复发，则患者被纳入研究。130例患者中有16例（12%）在最初成功消融后旁路传导复发。这些复发中几乎有一半（16例中的7例）发生在消融后的第1个12小时，最后一次发生在106天后。16例患者中有15例的初始复发指征为心电图（ECG）上的δ波恢复或自发性阵发性室上性心动过速。2例显性旁道患者复发，但均为隐匿性旁道传导，从三尖瓣环消融的旁道（右侧游离壁或间隔旁道）复发率（24%）远高于二尖瓣环（6%）。15例患者中有14例在首次复发后成功重复旁路消融。平均随访4 +/- 3个月后，这些旁道均无复发。结论：成功射频导管消融后，旁道复发是罕见的。除一次复发外，所有复发均经临床诊断，表明无症状患者不需要常规随访电生理检查。由于显性旁道可能仅在逆行传导时复发，因此消融后心悸的患者应进行电生理检查，即使ECG上未观察到δ波。复发后的消融成功率（93%）与首次消融的成功率相当，表明旁路功能恢复不应成为重复尝试的禁忌症。
The purpose of this study was to characterize the incidence and clinical features of accessory pathway recurrence after initially successful radiofrequency catheter ablation and to identify variables correlated with recurrence. Radiofrequency ablation was performed with a 7F deflectable tip catheter with a large (4 mm in length) distal electrode. Left-sided accessory pathways were approached through the left ventricle and right-sided pathways by way of the right atrium. Patients were included in the study if 1) they had an initially successful procedure, defined as the absence of accessory pathway conduction immediately after ablation, and 2) had undergone a 3-month follow-up electrophysiologic test or had documented recurrence of accessory pathway conduction.Accessory pathway conduction recurred after initially successful ablation in 16 (12%) of 130 patients. Almost half (7 of 16) of these recurrences were in the 1st 12 h after ablation, and the last occurred after 106 days. Return of delta waves on the electrocardiogram (ECG) or spontaneous paroxysmal supraventricular tachycardia was the initial indication of recurrence in 15 of the 16 patients. Two patients with manifest accessory pathways exhibited recurrence with exclusively concealed accessory pathway conduction.Accessory pathways ablated from the tricuspid anulus (right free wall or septal accessory pathways) had a much higher recurrence rate (24%) than did those on the mitral anulus (6%). Fourteen of 15 patients have had successful repeat accessory pathway ablation after the initial recurrence. After a mean follow-up period of 4 +/- 3 months, there have been no repeat recurrences of any of these accessory pathways.It is concluded that accessory pathway recurrence is infrequent after successful radiofrequency catheter ablation. All but one episode of recurrence was diagnosed clinically, suggesting that routine follow-up electrophysiologic testing in asymptomatic patients is not warranted. Because manifest accessory pathways may recur with retrograde conduction only, patients with palpitation after ablation should have electrophysiologic testing even if no delta waves are seen on the ECG. The success rate of ablation after recurrence (93%) is comparable to that achieved at the initial session, suggesting that return of accessory pathway function should not be a contraindication to a repeat attempt.