ELIMINATION OF ATRIOVENTRICULAR NODAL REENTRANT TACHYCARDIA USING DISCRETE SLOW POTENTIALS TO GUIDE APPLICATION OF RADIOFREQUENCY ENERGY
ELIMINATION OF ATRIOVENTRICULAR NODAL REENTRANT TACHYCARDIA USING DISCRETE SLOW POTENTIALS TO GUIDE APPLICATION OF RADIOFREQUENCY ENERGY
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DOI：
10.1161/01.cir.85.6.2162
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发表时间：
1992-06-01
期刊：
影响因子：
37.8
通讯作者：
WARIN, JF
中科院分区：
文献类型：
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作者：
HAISSAGUERRE, M;GAITA, F;WARIN, JF
背景慢径消融可通过手术方法或使用逆行慢径激动标测引导的射频导管技术消除房室结折返性心动过速（AVNRT）。从以前的经验，中间隔和后间隔映射，我们知道存在的特殊慢电位在大多数人。假设它们在AVNRT中的作用，我们研究了这些电位和射频能量的影响。研究了64例AVNRT患者（平均年龄48 ± 19岁）。当使用顺行AV传导系统时，记录慢，低振幅电位。慢电位占据了心房和心室电描记图之间的全部（给出连续的电描记图）或部分时间。他们最具体的模式是对心房率增加的进行性反应，这导致振幅和斜率急剧下降，持续时间相应增加，并与先前的心房电位分离，直到任何一致的活动消失。慢电位记录沿着一条垂直带在中间或后部的间隔附近的三尖瓣环。在慢电位部位施加放射性能量导致在几秒钟内中断诱导的心动过速，并使所有患者的心动过速不可诱导。在69%的患者中，消融后心房刺激无法实现长的心房-希氏间期，而这在以前是心动过速诱导或维持的关键。在1-16个月的随访期内，没有患者发生AVNRT，所有患者均保留了AV传导。除2例患者外，所有患者的PR间期均保持不变。在47例患者中，长期电生理研究证实了消融的有效性和异丙肾上腺素的不可逆性;然而，40%的患者仍有可诱导的回波搏动。人类的结周区域存在一个显示缓慢电位的区域。在房室结折返性心动过速患者中，射频能量的应用通过优先修饰顺行慢径使心动过速不可诱导。用目前的临床方法，这些生理电位的确切起源和意义无法确定。
Background. Ablation of the slow pathway has been performed to eliminate atrioventricular (AV) nodal reentrant tachycardia (AVNRT) either by a surgical approach or by using radiofrequency catheter technique guided by retrograde slow pathway activation mapping. From previous experience of midseptal and posteroseptal mapping, we were aware of the existence of peculiar slow potentials in most humans. Postulating their role in AVNRT, we studied these potentials and the effects of radiofrequency energy.Methods and Results. Sixty-four patients (mean age, 48+/-19 years) with the usual form of AVNRT were studied. Slow, low-amplitude potentials were recorded when using the anterograde AV conducting system. Slow potentials occupied all (giving a continuum of electrograms) or some of the time between the atrial and ventricular electrograms. Their most specific patterns were their progressive response to increasing atrial rates, which resulted in a dramatic decline in amplitude and slope, a corresponding increase in duration, and a separation from preceding atrial potentials until the disappearance of any consistent activity. Slow potentials were recorded along a vertical band at the mid or posterior part of the septum near the tricuspid annulus. Radiofrequency energy applied at the slow potential site resulted in interruption of induced tachycardia within a few seconds and rendered tachycardia noninducible in all patients. A median of two impulses was delivered to each patient In 69% of patients, postablation atrial stimulation cannot achieve a long atrial-His interval, which previously was critical for tachycardia induction or maintenance. No patient had AVNRT over a follow-up period of 1-16 months, and all had preserved AV conduction. In all except two patients, the PR interval was unchanged. In 47 patients, long-term electrophysiological studies confirmed the efficacy of ablation and the nonreversibility of results by isoproterenol; however, echo beats remained inducible in 40% of patients.Conclusions. An area showing slow potentials is present at the perinodal region in humans. In patients with AVNRT, application of radiofrequency energy renders tachycardia noninducible through the preferential modification of the anterograde slow pathway. With present clinical methods, the exact origin and significance of these physiological potentials cannot be specified.