Cryosurgical Ablation of Accessory Atrioventricular Connections: A Method for Correction of the Pre‐excitation Syndrome
Cryosurgical Ablation of Accessory Atrioventricular Connections: A Method for Correction of the Pre‐excitation Syndrome
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辅助房室连接的冷冻手术消融：一种纠正预激综合征的方法
DOI：
10.1161/01.cir.55.3.471
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发表时间：
1977
期刊：
影响因子：
37.8
通讯作者：
Robert W. Anderson
中科院分区：
文献类型：
--
作者：
J. Gallagher;W. Sealy;Robert W. Anderson
低温，一种明确治疗预激综合征的新技术，在两名患者中被描述。第一例患者表现为正常的P-R间期，伴有增量波和往复性心动过速。术前电生理检查显示左后房室沟有游离壁房室连接。手术时，心外膜标测证实了左心室后壁预激的位置。在最早的心室激动部位记录到从旁路(AP)发出的电信号。心房间延迟加上明显较长的旁路通向脑室，使P-R间期看起来正常。局部压力取消了预激。用专门设计的冷冻探头将早期的心室激活部位冷却到−60°C。所有预激和心律失常的证据都消失了。第二例患者表现为顽固性往复性心动过速，并被发现在间隔内有一个只能逆行传导的AP。在心动过速期间，将0°C的温度施加到该部位的环处，可取消逆传。复温后，AP传导和往复性心动过速恢复。AP的消融是通过在同一区域两次施加−60°C的90秒的温度来获得的。希氏束没有受伤。
Cryothermia, a new technique for definitive treatment of the pre-excitation syndrome, is described in two patients. The first patient presented with a normal P-R interval with a delta wave and reciprocating tachycardia. Preoperative electrophysiologic study suggested a free-wall atrioventricular connection on the left posterior atrioventricular (A-V) groove. At surgery, epicardial mapping confirmed the site of pre-excitation on the posterior left ventricular (LV) wall. An electrogram arising from the accessory pathway (AP) was recorded at the site of earliest ventricular activation. Interatrial delay combined with an apparently long accessory pathway to the ventricle caused the P-R interval to appear normal. Local pressure abolished pre-excitation. The site of early ventricular activation was cooled to −60°C with a specially designed cryoprobe. All evidence of pre-excitation and arrhythmias disappeared. The second patient presented with a refractory reciprocating tachycardia and was found to have an AP in the septum capable of only retrograde conduction. Retrograde conduction was abolished by applying a temperature of 0°C to the anulus at this site during tachycardia. Conduction over the AP and reciprocating tachycardia returned with rewarming. Ablation of the AP was obtained by applying a temperature of −60°C for 90 seconds on two occasions to the same area. The His bundle was not injured.