导管激光切断右侧房室附加旁路的实验研究

An Experimental Study on Interrupting Atrioventricular Accessory Pathways Using Transcatheter Laser Ablation

本实验研究的目的在于探讨用导管激光切断右侧房室附加旁路的效果及其对三尖瓣环和心肌损伤范围。使用了不同剂量的Nd:YAG导管激光。10只成年犬,分为二组:一组为低功率(5W)长时间(19～25秒)照射,另一组为高功率(17～25W)短时间(5秒)照射。结果表明,右心衰竭、右冠状动脉损伤及三尖瓣口返流皆未发生。3周后,心室程序刺激皆不能诱发出持续性室性心动过速。低功率长时间照射比高功率短时间照射更为有效而安全,且并发症少。在病变区内曾发现2个异物性肉芽肿,乃由光导纤维尖端在照射时破裂所致。

The purpose of this study is to make clear about the effectiveness and morphologic changes of the endocardial ablation near tricuspid anulus (TA) using the different energy of transcatheter Nd: YAG laser. Ten adult dogs were divided into two groups (low power [5W], long duration [19-25 seconds] and high power [17-25W], short duration [5 seconds]). The result showed that the ratio of A/V in endocardial ECG of right atrium can be served as the index to judge the distance between lesion area and TA Neither right heart failure right c orGnary injury, nor regurgitation of tricuspid valve occurred. Three weeks after ablation, no sustained ventricular tachycardia was induced by programmed ventricular stimulation Meanwhile, the laser ablation of low power, long duration was more effective and safe with less complications than high power, short duration. Two foreign body granuloma were found in the lesion region, which was caused by the fibertip broken down during the ablation. In conclusion, the use of transcatheter Nd: YAG laser to interrupt right APs near tricupid anulus was effective and safe, but the high power and short duration laser irradiation should be used carefully.