Radiofrequency ablation of atrial flutter: a randomized controlled study of two anatomic approaches.
Radiofrequency ablation of atrial flutter: a randomized controlled study of two anatomic approaches.
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心房扑动的射频消融：两种解剖方法的随机对照研究。
DOI：
10.1111/j.1540-8159.2004.00390.x
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发表时间：
2004
期刊：
影响因子：
--
通讯作者：
Goldberger,JeffreyJ
中科院分区：
文献类型：
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作者：
Passman,RodS;Kadish,AlanH;Dibs,SamerR;Engelstein,EricaD;Goldberger,JeffreyJ
心房扑动通常是由以右心房内的解剖结构为边界的大折返性回路引起的。在强制性峡部部位进行射频消融可以消除心房扑动回路。本研究的目的是比较两种房扑消融途径：间隔(三尖瓣环至冠状静脉窦口和咽鼓脊)与后入路(下腔静脉至三尖瓣环)。20名患者被随机分为“间隔”入路或“后方”入路。对心房扑动和窦性心律正常的患者分别进行基线下的夹带标测和/或双向峡部传导的确认。射频消融采用标准导管和技术。在两行射频损伤后允许交叉。终点包括急性成功率和透视时间。使用意向治疗分析，两种方法的成功率在统计学上没有显著差异。隔入路透视时间为58.4±30.3分钟，后入路透视时间为70.8±31.1分钟(P=0.7)。在使用间隔入路的患者中，有更频繁的交叉，而且使用该入路的一个主要并发症房室传导阻滞也会发生。房扑消融的成功率或透视时间在间隔消融和后部消融之间没有统计学意义上的差异。然而，考虑到间隔入路房室传导阻滞的风险，后入路应该是首选的初始入路。(Pace 2004；27：83-88)
Atrial flutter often results from a macroreentrant circuit that uses anatomic structures within the right atrium as its borders. RF ablation at the site of an obligatory isthmus can eliminate the atrial flutter circuit. The aim of this study was to compare two approaches to atrial flutter ablation: the septal (septal aspect of the tricuspid valve annulus to coronary sinus ostium and Eustachian ridge) approach versus the posterior (inferior vena cava to tricuspid valve annulus) approach. Twenty patients were randomized to either the “septal” or “posterior” approach. Entrainment mapping and/or confirmation of bidirectional isthmus conduction at baseline were performed in those patients in atrial flutter and normal sinus rhythm, respectively. RF ablation was performed with standard catheters and techniques. Crossover was permitted after two lines of RF lesions. Endpoints included acute success rates and fluoroscopy times. There was no statistically significant difference in the success rate between the two approaches using intention‐to‐treat analysis. Fluoroscopy times in the septal versus posterior approaches were 58.4 ± 30.3 versus 70.8 ± 31.1 minutes, respectively (P = 0.7). There was more frequent crossover in patients assigned to the septal approach and the one major complication, atrioventricular block, also occurred using this approach. There was no statistically significant difference in the success rate or fluoroscopy times between the septal and posterior approaches to atrial flutter ablation. However, given the risk of atrioventricular block with the septal approach, the posterior approach should be the preferred initial choice. (PACE 2004; 27:83–88)