A Low Amplitude His-Bundle Potential Predicts Failure of the Right-Sided Approach for Atrioventricular Junction Ablation
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概要
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In 30 patients with drug refractory atrial fibrillation-flutter who underwent radiofrequency(RF) ablation of the atrioventricular(AV) junction, 23 were successfully ablated using the conventional right-sided approach (group A). Seven patients required a left-sided approach (group B) after multiple applications from the conventional right-sided approach failed to produce complete AV block. The amplitude of the His-bundle potential recorded at the ablation site differed significantly between the 2 groups (0.23±0.11 mV in group A vs 0.12±0.04 mV in group B; p<0.005). Also, the amplitude of the His-bundle potential recorded in the standard position across the tricuspid annulus differed significantly between the 2 groups (0.27±0.35 mV in group A vs 0.11±0.44 mV in group B; p<0.007). There was no significant difference in the amplitude of the ventricular potential between the 2 groups. The probability of successful ablation of the AV junction with a conventional right-sided approach was 6 out of 12 patients (50%) if the His amplitude was <0.12 mV, and 17 out of 18 patients (94%) if the His amplitude was >0.12 mV (p<0.005). Patients in group B had a mean of 20.5±13.0 failed right-sided RF applications (5-33 applications), but required a mean of only 2 subsequent RF applications for success on the left side (1-6 applications). The His-amplitude recorded from the left side using the same catheter was significantly greater than that on the corresponding right-side (0.22±0.09 mV on the left side vs 0.12±0.04 mV on the right side: p<0.05). Total mean fluoroscopic time was 62±12 min for group B and 20±13 min for group A patients. In patients that underwent RF ablation of the AV junction, a maximum His amplitude <0.12 mV predicted a success rate of approximately 50% in the present study. An early switch to a left-sided approach may avoid multiple RF applications and prolonged fluoroscopic time in patients with a low amplitude His-bundle potential.
- 社団法人日本循環器学会の論文
- 2000-03-20
著者
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Abe Haruhiko
The Second department of Internal Medicine, University of Occupational and Environmental Health
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Abe Haruhiko
The Second Department Of Internal Medicine University Of Occupational And Environmental Health
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Cannom David
Division Of Cardiology The Hospital Of The Good Samaritan Los Angeles California Usa
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Cannom David
Division Of Cardiology The Hospital Of The Good Samaritan
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Lerman Robert
Division Of Cardiology The Hospital Of The Good Samaritan
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Bhandari Anil
Division of Cardiology, The Hospital of the Good Samaritan
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Isber Nidal
Division of Cardiology, The Hospital of the Good Samaritan
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Abdullah Edward
Division of Cardiology, The Hospital of the Good Samaritan
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Firth Beverly
Division of Cardiology, The Hospital of the Good Samaritan
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Bhandari Anil
Division Of Cardiology The Hospital Of The Good Samaritan
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Firth Beverly
Division Of Cardiology The Hospital Of The Good Samaritan
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Isber Nidal
Division Of Cardiology The Hospital Of The Good Samaritan
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Abdullah Edward
Division Of Cardiology The Hospital Of The Good Samaritan
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