CATHETER ABLATION OF ACCESSORY ATRIOVENTRICULAR PATHWAYS (WOLFF-PARKINSON-WHITE SYNDROME) BY RADIOFREQUENCY CURRENT
CATHETER ABLATION OF ACCESSORY ATRIOVENTRICULAR PATHWAYS (WOLFF-PARKINSON-WHITE SYNDROME) BY RADIOFREQUENCY CURRENT
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DOI：
10.1056/nejm199106063242301
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发表时间：
1991-06-06
影响因子：
158.5
通讯作者：
LAZZARA, R
中科院分区：
文献类型：
--
作者：
JACKMAN, WM;WANG, XZ;LAZZARA, R
背景 通过高能量电击进行旁路的手术或导管消融可作为Wolff-Parkinson-白色综合征患者的确定性治疗，但具有显著相关的发病率和死亡率。 射频电流是消融的替代能源，在远离电流输送部位的地方产生较小的损伤，而不会产生不良影响。 我们进行这项研究的目的是开发导管技术来输送射频电流，以减少与旁路消融相关的发病率和死亡率。 通过对着二尖瓣或三尖瓣环或冠状窦分支定位的导管电极施加射频电流（平均功率，30.9 +/- 5.3 W）;如可能，通过导管记录的附件通路激活引导输送。 166例患者共消融177条旁路，其中左侧游离壁106条，前间隔区13条，后间隔区43条，右侧游离壁15条。 166名患者中有164名（99%）通过平均三次射频电流应用消除了旁路传导。在平均8.0 +/- 5.4个月的随访（+/- SD）期间，15例患者（9%）出现预激或房室折返性心动过速。 所有患者均接受了第二次成功消融。 75例患者消融后3.1 +/- 1.9个月的电生理研究证实所有患者均无副通路传导。 3例患者（1.8%）发生射频电流应用并发症：房室传导阻滞（1例）、心包炎（1例）和在冠状窦小分支中应用射频电流后心脏压塞（1例）。 射频电流消融旁路非常有效，发病率低，无死亡率。
Background. Surgical or catheter ablation of accessory pathways by means of high-energy shocks serves as definitive therapy for patients with Wolff-Parkinson-White syndrome but has substantial associated morbidity and mortality. Radiofrequency current, an alternative energy source for ablation, produces smaller lesions without adverse effects remote from the site where current is delivered. We conducted this study to develop catheter techniques for delivering radiofrequency current to reduce morbidity and mortality associated with accessory-pathway ablation.Methods. Radiofrequency current (mean power, 30.9 +/- 5.3 W) was applied through a catheter electrode positioned against the mitral or tricuspid annulus or a branch of the coronary sinus; when possible, delivery was guided by catheter recordings of accessory-pathway activation. Ablation was attempted in 166 patients with 177 accessory pathways (106 pathways in the left free wall, 13 in the anteroseptal region, 43 in the posteroseptal region, and 15 in the right free wall).Results. Accessory-pathway conduction was eliminated in 164 of 166 patients (99 percent) by a median of three applications of radiofrequency current. During a mean follow-up (+/- SD) of 8.0 +/- 5.4 months, preexcitation or atrioventricular reentrant tachycardia returned in 15 patients (9 percent). All underwent a second, successful ablation. Electrophysiologic study 3.1 +/- 1.9 months after ablation in 75 patients verified the absence of accessory-pathway conduction in all. Complications of radiofrequency-current application occurred in three patients (1.8 percent): atrioventricular block (one patient), pericarditis (one), and cardiac tamponade (one) after radiofrequency current was applied in a small branch of the coronary sinus.Conclusions. Radiofrequency current is highly effective in ablating accessory pathways, with low morbidity and no mortality.