Koch三角下位与中位线性消融对治疗常规消融方法困难的房室结折返性心动过速的比较

Comparison of linear ablation at low and mid-level of Koch's triangle in treatment of atrioventricular nodal reentrant tachycardia refractory to conventional slow pathway modification

目的:比较常规消融方法困难的房室结折返性心动过速(AVNRT)Koch三角下位与中位线性消融两种方法的有效性和安全性。方法:回顾性分析比较常规消融方法困难的房室结折返性心动过速Koch三角下位线性消融(三尖瓣环至冠状窦口中部)和中位线性消融(三尖瓣环至希氏束与冠状窦口连线的中下1/3交界水平)的手术成功率、慢径消除率、放电时间和操作时间。结果:下位和中位线性消融均具有较高的成功率(94.4%、100%)。在放电时间上,下位法消融组显著高于中位法线性消融[(578±177)m svs(481±185)m s,P<0.01],而整个手术操作时间,下位法组要明显低于中位法[(153±51)m svs(199±56)m s,P<0.01)]。在消融过程中,中位法出现1例一过性Ⅰ度房室传导阻滞,两组无任何程度的持续房室传导阻滞发生。结论:对常规方法消融后复发的AVNRT,Koch三角下位线性消融与中位线性消融方法均较为安全,但下位法可能操作更简洁。

AIM： To compare the efficacy and safety of low and mid-level linear ablations at Koch＇s triangle in the treatment of atrioventricular nodal reentrant tachyeardia （AVNRT） refractory to conventional slow pathway modification. METHODS： In cases with AVNRT refractory to conventional ablation, elimination of slow pathway, rate of success, time of radiofrequency （RF） delivery and total procedure time were compared between the linear ablations at the low and mid-level of Koch＇s triangle. RESULTS ： No significant difference was seen in the rate of success and the elimination of slow pathway between the groups. However, the time of RF energy delivery at the low level of Koch＇s triangle was longer than that of mid-level linear lesion [ （578. 1±177.4） ms vs. （481.3±185.2） ms, P 〈0. 01 ]. Moreover, the time needed for the total procedure was shorter by low linear ablation compared with that by mid-level linear ablation [ （ 152. 8±51.2） ms vs. （ 198.6±56. 1 ） ms, P 〈 0. 01 ]. One patient showed transient onedegree AV block during linear lesion at the mid-level of Koch＇s triangle and no permanent AV block occurred during the entire procedure. CONCLUSION： Both low and mid-level linear ablations at Koch＇s triangle are effective and safe in the treatment of the AVNRT refractory to conventional slow pathway modification. However, the procedures of low level linear ablation may be simpler, and mid-level linear ablation could be a backup approach.