관상동맥동내 전극도자를 이용한 좌측 우회로의 전기적 절제술 = Catheter Ablation of Left - Sided Accessory Pathways Via The Coronary Sinus

다국어 초록 (Multilingual Abstract)

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다국어 초록 (Multilingual Abstract)

Background: Surgical treatment has been reserved for treatment of paroxysmal or incessant bypass tract mediated reentrant tachycardia refractory to medical management. During the past decade, catheter ablative techniques have been introduced that replicate the surgical experience without expense and morbility associated with cardiac surgery. Methods: Catheter ablation (CA) of accessory pathway (AP) via the coronary sinus (CS) was performed in 70patients (43male, 27female) with symptomatic supraventricular tachyarrhythmias. Thirty one patients had manifest AP and 39had concealed AP. Sixty one patients had left. free wall AP and 9had posteroseptal AP. Two to 6unipolar D.C shocks (80-100J) were delivered between the electrode (cathode) close to the AP in the CS and a patch electrode (anode) placed on the posterior or lateral chest wall in each patient. Six patients received additional 1 to 2unipolar shocks of 200J via electrically common pair of electrodes {cathode). One to 2additional bipolar shocks (80J) were delivered via two electrodes close to the AP in the CS in the first 5patients. Results: Immediately after the shock was delivered, ventriculoatrial conduction via AP was abolished in all patients and anterograde AP conduction was eliminated in each patient with preexcitation. Two patients had prolonged sinus pause requring pacing for 10min. One who received 1shock of 200J required emergency surgery for a ruptured coronary sinus. One patient who received 3shocks of 100J developed cardiac tamponade requiring needle pericardiocentesis. Other complications were accelerated junctional rhythm in 8patients, nonsustained slow ventricular tachycardia in 2patients and an asymptomtic pericardial effusion in 2patients. Sixteen patients had recurrence within 2months (initial success rate of 77%. 54/70). Five underwent second ablation with successful result in 2, The overall longterm success rate (6-57mos, mean follow-up=24.6±7.4mos) was 80% (56/70), Mean peak CK-MB reached 34.8±23.8 IU/L (control CK-MB 6.0±5.4 IU/L). Conclusions: Although CA carries some life- threatening risk, it may be an effective alternative to surgical ablation of the left-sided AP in a selected group of patients.