导管电灼希司束对狗心电活动的影响

The effects of catheter electric ablation of His-bundle on electrocardiac activity in dogs

对63条狗以10J/kg(32条)和15J/kg(31条)两组能量用导管电灼希司米。造成持久性3°房室阻滞(AVB)的成功率分别为25％与75％,高能量组显著大于低能量组(P<0.001)。本法造成的AVB位于房室结和希司束内,但电灼对心电活动的影响是广泛的,可影响窦房结功能,室内传导(尤其右束支)及诱发近期室性异位心律,少数可促发房性和远期室性异位心律。希司束电灼术在高能电灼时有直接诱发室颤的危险性。术后在平均123.6天的观察期内,不论是否形成3°AVB均有相当高的猝死率。

We studied the effects of catheter electric ablation of His bundle on electro cardiac aetirity in 63 dogs. To establish permanent complete atrioventrieular block(PCAVB), the high energy ablation group(15J/kg)had higher success rate than that of low energy group(10J/kg), (21/31 vs 8/32, P<0.001). With this method the PCAVB was located at atrioventricular node and His bundle, but also had wide effects on sinus node function, right bundle branch and intraventricular conduction, and might induce early or delayed atrial or ventricular ectopic arrhythmias. The ventricular fibrillation might be precipitated particularly in high energy group. Both high and low energy groups and both PCAVB and non PCAVB groups had relatively high risk of sudden death. During PCAVB the ventricular rate decreased to one third and one third of PCAVB had multifocal idioventricular rhythm. Occasionally, sick sinus syndrome may also occur, so after ablation a pacemaker implant may be reasonable.