Catheter ablation of the atrioventricular junction with radiofrequency energy.
Catheter ablation of the atrioventricular junction with radiofrequency energy.
复制标题
用射频能量对房室交界处进行导管消融。
DOI：
10.1161/01.cir.80.6.1527
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发表时间：
1989
期刊：
影响因子：
37.8
通讯作者：
Scheinman,MM
中科院分区：
文献类型：
--
作者：
Langberg,JJ;Chin,MC;Rosenqvist,M;Cockrell,J;Dullet,N;VanHare,G;Griffin,JC;Scheinman,MM
使用直流除颤器放电进行房室交界处的导管消融需要全身麻醉，并且可能有严重的副作用。16例药物难治性室上性心动过速患者接受了使用射频能量的房室交界处导管消融术。放置标准7 F四极电极导管，以记录远端电极的最大单极His电位（580 +/- 640 microV）。电凝器（Microvasive Bicap 4005）以550 kHz提供连续的未调制能量。在远端电极和大直径胸壁电极之间输送1 - 14次射频电流。16例患者中有7例报告一过性轻度胸部不适。在射频消融过程中，无明显心律失常或血压变化。16例患者中有9例出现完全性房室传导阻滞，1例出现高度二度房室传导阻滞。在其余6例患者中仍然可以记录到衰减的希氏束电描记图，其中4例在同一疗程中使用直流电休克成功进行了房室交界处消融。在平均4.2个月的随访期间，所有10例成功接受射频消融治疗的患者均持续存在房室传导阻滞。与一组接受直流电电击消融治疗的历史对照受试者相比，10例成功接受射频治疗的患者的肌酸激酶-MB同工酶释放显著更少（5.7 +/- 5.1 vs. 22 +/- 13 IU，p = 0.006）。射频诱发房室传导阻滞后，所有患者均出现交界性逸搏心律。相比之下，10名对照组患者中有3名在直流电电击消融后出现了心室自主逸搏，4名患者完全没有逸搏节律。（250字处删节）
Catheter ablation of the atrioventricular junction using direct-current defibrillator discharges requires general anesthesia and may have serious side effects. Sixteen patients with drug-refractory supraventricular tachycardia underwent catheter ablation of the atrioventricular junction using radiofrequency energy. A standard 7F quadripolar electrode catheter was positioned to record the largest unipolar His potential (580 +/- 640 microV) from the distal electrode. An electrocoagulator (Microvasive Bicap 4005) supplied continuous, unmodulated energy at 550 kHz. One to 14 applications of radiofrequency current were delivered between the distal electrode and a large-diameter chest wall electrode. Transient, mild chest discomfort was reported by seven of 16 patients. None had significant arrhythmias or blood pressure changes during radiofrequency ablation. Complete atrioventricular block was produced in nine of 16 patients and high-grade second-degree atrioventricular block was produced in one patient with radiofrequency current. Attenuated His bundle electrograms could still be recorded in the remaining six patients, four of whom underwent successful atrioventricular junctional ablation using direct-current shock during the same session. Atrioventricular block persisted in all 10 patients successfully treated with radiofrequency ablation during a mean follow-up of 4.2 months. Compared with a group of historic control subjects treated with direct-current shock ablation, the 10 patients successfully treated with radiofrequency current had significantly less creatine kinase-MB isoenzyme release (5.7 +/- 5.1 vs. 22 +/- 13 IU, p = 0.006). A junctional escape rhythm was present in all patients after radiofrequency-induced atrioventricular block. In contrast, three of 10 control patients had an idioventricular escape after direct current shock ablation, and four patients had no escape rhythm at all.(ABSTRACT TRUNCATED AT 250 WORDS)