Transvenous Radiofrequency Ablation Theraphy as an Effective and Safe Method for The Treatment of The Slow Pathway Of Atrioventricular Nodal Re-Entrant Tachycardia

Yıl 2011, Cilt: 14 Sayı: 2, 51 - 55, 01.02.2010

Mustafa Yıldız Ahmet Cağrı Aykan Serdar Demir Mehmet Özkan

Öz

Background: The typical atrioventricular nodal re-entrant tachycardia (AVNRT) can be cured with the slow pathway ablation. In this study, we have analyzed a consecutive series of patients with typical AVNRT who underwent slow-pathway ablation which is a safe, effective and reproducible strategy using radiofrequency (RF) energy. Patients and Method: Fifty consecutive patients with symptomatic drug-resistant typical (slow-fast) AVNRT underwent an invasive electrophysiology study and RF ablation (RFA) of slow conduction pathway within atrioventricular (AV) node. The endpoints of ablation were induction of a retrogradely conducted junctional rhythm, and non-inducibility of AVNRT on atropine. Results: Fifty consecutive patients (age: 42.5 ± 15.4 years, body mass index: 25.56 ± 3.67 kg/m2, waist/hip ratio: 0.84 ± 7.164E-02, systolic blood pressure: 119.20 ± 13.57 mmHg, diastolic blood pressure: 74.40 ± 8.06 mmHg, rest heart rate: 76.20 ± 7.25 beat/min) with slow-fast AVNRT (40 women, 10 men) were ablated. AVNRT was induced during electrophysiological study. RFA successfully eliminated tachyarrhythmia in 50 (100%) patients. The AH interval was decreased in the post-ablation period as compared with pre-ablation period and no immediate conduction disturbances. Procedure and fluoroscopy times were 65.4 ± 19.0 and 13.4 ± 3.6 min respectively. No patient presented with AV block of any degree. Conclusions: The transvenous radiofrequency ablation therapy is a safe and effective approach for AVNRT, but care should be taken to use it in a way with full understanding of its possibilities and limitations, otherwise it could lead to disappointing results.

Anahtar Kelimeler

Tachycardia, Atrioventricular Nodal Reentry, Ablation Techniques, AtriOventricular Block.

Atriyoventriküler Nodal Re-Entran Taşikardide Yavaş Yolun Etkili ve Güvenilir Bir Metod Olan Transvenöz Radyofrekans İle Ablasyonu

Öz

Giriş: Tipik atriyoventriküler nodal re-entran taşikardi (AVNRT) yavaş yol ablasyonu ile tedavi edilebilir. Biz bu çalışmada radyofrekans (RF) enerjisini kullanan ve güvenli, etkili ve yeniden üretilebilir bir strateji olan yavaş yol ablasyonunu geçirmiş tipik AVNRT'li ardışık hasta serisini analiz ettik.Hastalar ve Metod: Semptomatik ilaca dirençli tipik (yavaş-hızlı) AVNRT'li elli ardışık hastaya invaziv elektrofizyoloji çalışması ve atriyoventriküler (AV) içinde yavaş iletim yolunun RF ablasyonunu (RFA) yapıldı. Ablasyonun son noktaları retrograd iletimli kavşak ritminin uyarılması ve atropin üzerinden AVNRT'nin uyarılamaması idi. Bulgular: Yavaş-hızlı AVNRT'li (40 kadın, 10 erkek) elli ardışık hasta (yaş: 42.5 ± 15.4 yıl, vücut kitle indeksi: 25.56 ± 3.67 kg/m2, bel/kalça oranı: 0.84 ± 7.164E-02, sistolik kan basıncı: 119.20 ± 13.57 mmHg, diyastolik kan basıncı: 74.40 ± 8.06 mmHg, istirahat kalp hızı: 76.20 ± 7.25 atım/dakika) ablate edildi. AVNRT elektrofizyolojik çalışma sırasında uyarıldı. RFA taşiaritmiyi 50 (%100) hastada başarıyla dışladı. AH aralığı pre-ablasyon periyotla kıyaslayınca post-ablasyon periyotta azaldı ve hızlı iletim bozukluğu yoktu. Prosedür ve floroskopi zamanları sırasıyla 65.4 ± 19.0 ve 13.4 ± 3.6 dakikaydı. Hastalar herhangi bir derecede AV bloğu göstermedi. Sonuç: Transvenöz radyofrekans ablasyon tedavisi AVNRT için güvenli ve etkili bir yaklaşımdır, fakat kullanımı için olasılıklarını ve limitlerini tamamen anlayarak dikkatli olunmalıdır, aksi taktirde hayal kırıklığı ile sonuçlanabilir.

Anahtar Kelimeler

Taşikardi, Atrioventriküler Düğüm Yeniden Girişi, Ablasyon Teknikleri, Atriyoventriküler Blok.

Kaynakça

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