背景:在所谓的慢速路径(SP)RF消融期间,射频(RF)消融目标可能位于紧凑型房室结(AVN)区域,可能导致短暂性或永久性房室传导阻滞(AVB)。然而,相关数据很少见。
方法:在715名连续接受房室结折返性心动过速射频消融的患者中,随后有17名患者经历了短暂性或永久性AVB,并被纳入这项回顾性观察研究。
结果:在17例患者中,两名患者(11.8%)出现一过性一级AVB,4例患者(23.5%)出现短暂性二度AVB,7例患者(41.2%)出现短暂性三度AVB,4例患者(23.5%)发展为永久性三度AVB。在射频消融开始前的基线窦性心律期间,射频消融导管未记录到希氏束电位.在导致暂时性或永久性房室传导阻滞的所谓SP射频消融期间,17例患者中有14例(82.4%)出现交界性心律伴心室房室传导阻滞,随后出现AVB,和低振幅,在17例患者中,有7例(41.2%)在射频消融开始前记录了低频驼峰状心房电位.17例患者中有3例发生直接AVB(17.6%),和低振幅,所有3例患者在射频消融开始前记录低频驼峰型心房电位.
结论:低振幅,在所谓的SP区域记录的低频驼峰状心房电位可以反映紧凑AVN激活的电描记图,即使没有记录到希氏束电位,对该部位进行射频消融也预示着AVB即将发生。
BACKGROUND: The radiofrequency (RF) ablation target may be located at the compact atrioventricular node (AVN) region during so-called slow pathway (SP) RF ablation, potentially leading to transient or permanent atrioventricular block (AVB). However, related data are rare.
METHODS: Among 715 index consecutive patients who underwent RF ablation for atrioventricular nodal re-entry tachycardia, 17 patients subsequently experienced transient or permanent AVB and were included in this retrospective observational study.
RESULTS: Among the 17 patients, two patients (11.8%) developed transient first-degree AVB, four patients (23.5%) developed transient second-degree AVB, seven patients (41.2%) developed transient third-degree AVB, and four patients (23.5%) developed permanent third-degree AVB. During baseline sinus rhythm before the start of RF ablation, no His-bundle potential was recorded from the RF ablation catheter. During the so-called SP RF ablation that led to transient or permanent AVB, junctional rhythm with ventriculoatrial (VA) conduction block followed by subsequent AVB was observed in 14 of 17 patients (82.4%), and a low-amplitude, low-frequency hump-shaped atrial potential was recorded before the start of RF ablation in 7 of the 17 patients (41.2%). Direct AVB occurred in 3 of the 17 patients (17.6%), and a low-amplitude, low-frequency hump-shaped atrial potential was recorded before the start of RF ablation in all 3 patients.
CONCLUSIONS: The low-amplitude, low-frequency hump-shaped atrial potential recorded at the so-called SP region may reflect the electrogram of compact AVN activation, and RF ablation to this site heralds impending AVB even when a His-bundle potential is not recorded.