medigraphic.com

2000, Número 4

<< Anterior Siguiente >>

Arch Cardiol Mex 2000; 70 (4)


Experiencia en 1,500 pacientes sometidos a ablación con radiofrecuencia en el tratamiento de las taquicardias

Iturralde TP, Colín LL, Guevara VM, Rodríguez CL, Kershenovich SS

Idioma: Español
Referencias bibliográficas: 89
Paginas: 349-356
Archivo PDF: 427.70 Kb.


RESUMEN

Reportamos los resultados de la ablación con Radiofrecuencia (RF) en 1500 pacientes con taquicardias, tratadas en el Instituto Nacional de Cardiología “Ignacio Chávez” desde abril de 1992 a diciembre de 1999. La taquicardia era debida a la presencia de una vía accesoria en 987 pacientes (65.8%), con un total de 1,012 vías accesorias; sólo 24 pacientes tuvieron dos o tres vías accesorias. El mecanismo de la arritmia fue reentrada intranodal (REIN) en 321 (21.4%) pacientes. Se realizó ablación del circuito de reentrada en 109 (7.2%) pacientes con flutter auricular (FLA) y, en 26 (1.7%), se realizó ablación del nodo aurículo-ventricular (A-V) por fibrilación o flutter auricular recurrente a pesar del tratamiento médico. En 13 pacientes (0.8%) se realizó ablación de una taquicardia auricular por foco ectópico (TAE), en 7 (0.4%) con taquicardia por reentrada intrauricular (TRIA) y en 37 (2.4%) se realizó ablación con radiofrecuencia de una taquicardia ventricular (TV). La ablación con radiofrecuencia fue exitosa en 908/1012 (89.7%) vías accesorias, con recurrencia en 92 casos (9%) y complicaciones en 10 (0.98%). La reentrada intranodal fue tratada con éxito en 3l9/32l pacientes con ablación selectiva de la vía lenta en 297/32l (92.5%) y de la vía rápida en 22/24 (92%). El porcentaje de complicaciones en este grupo fue de 2.4%, = 8 pacientes: 4 con bloqueo aurículo-ventricular completo (1.1%) requiriendo la implantación de marcapaso en 3. En el caso del flutter auricular, se obtuvo éxito en 86/109 pacientes (76.8%). Se realizó bloqueo AV completo por ablación de la unión aurículo-ventricular en 26/26 (100%) pacientes. Se realizó ablación exitosa en 5/13 (38.4%) pacientes con taquicardia auricular ectópica y en 3/7 (46%) pacientes de una taquicardia por reentrada intrauricular. Finalmente obtuvimos éxito en 28/37 (75.6%) de pacientes con taquicardia ventricular. El éxito total de la serie fue de ablación exitosa mediante radiofrecuencia en l375 pacientes (91.6%), con 142 recurrencias (9.4%) y 15 complicaciones (1%), sin mortalidad.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Gallagher JJ, Svenson RH, Kasell JH, German LD, Bardy GH, Broughton A, et al: Catheter technique for closed chest ablation of the atrioventricular conduction system. N Engl J Med 1982; 306: 194-200.

  2. Scheinman H, Morady F, Hess DS, González R: Catheter induced ablation of the atrioventricular junction to control refractory supraventricular arrhythmias. JAMA 1982; 248: 851-855.

  3. Zipes DP: Catheter ablation of arrhythmias. Armowk NK. Futura Publishing Company, 1994: 1-335.

  4. Kadish A, Golberger J: Ablative therapy for atrioventricular nodal reentry arrhythmias. Prog Cardiovasc Dis 1995; 37(5): 273-293.

  5. Plumb VJ: Catheter ablation of the accessory pathways of Wolff Parkinson White syndrome and its variants. Prog Cardiovasc Dis 1995; 37(5): 295-306.

  6. Huang SK, Bharatis S, Graham AR: Closed chest catheter desiccation of the atrioventricular junction using radiofrequency energy: A new method of catheter ablation. J Am Coll Cardiol 1987; 9: 349-356.

  7. Goy JJ, Fromer M, Schlaepter J, Kappenberger L: Clinical efficacy of radiofrequency current in the treatment of patients with atrioventricular node reentrant tachycardia. J Am Coll Cardiol 1990; 16: 418-423.

  8. Lee Ma, Morady F, Kadish A, Schamp DJ, Chin MC, Scheinman MM, et al: Catheter modification of the atrioventricular junction with radiofrequency energy for control of atrioventricular nodal reentrant tachycardia. Circulation 1991; 83: 827-835.

  9. Morady F, Scheinman MM, Winston SA, Dicarlo LA, Davis JC, Griffin JC, et al: Efficacy and safety of transcatheter ablation of posteroseptal accessory pathways. Circulation 1985; 72: 170-177.

  10. Borggrefe M, Buddle T, Podczek A, Breithardtt G: High frequency altenating current ablation of an accessory pathway in humans. J Am Coll Cardiol 1987; 10: 576-582.

  11. Warin JF, Haissaguerre M, Le Metayer P, Guillen JP, Blanchot P: Catheter ablation of accessory pathways with a direct approach results in 35 patients. Circulation 1988; 78: 800-815.

  12. Warin JF, Haissaguerre M, D’Ivernois, Metayer P, Montserrat P: Catheter ablation of accessory pathways technique and results in 248 patients. PACE 1990; 13: 1609-1614.

  13. Jackman WM, Wang X, Friday KJ, Roman CA, Moulton KP, Beckman KJ, et al: Catheter ablation of accessory atrioventricular pathways (WPW syndrome) by radiofrequency current. N Engl J Med 1991; 324: 1605-1611.

  14. Schluter M, Kuck KH: Catheter ablation from right atrium of anteroseptal accessory pathways using radiofrequency current. J Am Coll Cardiol 1992; 19: 663-670.

  15. Calkins H, Langberg JJ, Sousa J, Atassi R, Leon A, Kou W, et al: Radiofrequency catheter ablation of accessory atrioventricular connections in 250 patients abbreviated therapeutic approach to Wolff Parkinson White syndrome. Circulation 1992; 85: 1337-1346.

  16. Kuck KH, Schluter M: Single-catheter approach to radiofrequency current ablation of left sided accessory pathways in patients with Wolff Parkinson White syndrome. Circulation 1991; 84: 2366-2375.

  17. Epstein LM, Scheinman MM, Langberg JJ, Chilson D, Goldberg HR, Griffin JC: Percutaneous catheter modification of the atrioventricular node. Circulation 1989; 80: 757-768.

  18. Lee Ma, Morady F, Kadish A: Catheter modification of the atrioventricular junction with radiofrequency energy for control of atrioventricular nodal reentry tachycardia. Circulation 1991; 83: 827-935.

  19. Kay GN, Ebstein AE, Dailey SM: Selective radiofrequency ablation of the slow pathway for the treatment of atrioventricular nodal reentrant tachycardia. Evidence for involvement of perinodal myocardium within the reentrant circuit. Circulation 1992; 85: 1675-1688.

  20. Jazayeri MR, Hempe SL, Sra JS: Selective transcatheter ablation of the fast and slow pathways using radiofrequency energy with atrioventricular nodal reentrant tachycardia. Circulation 1992; 85: 1318-1328.

  21. Kay GN, Ebstein AE, Dailey SM: Radiofrequency ablation for treatment of primary atrial tachycardia. J Am Coll Cardiol 1993; 21: 901-909.

  22. Jackman WM, Beckman KS, Mc Cletand JH: Treatment of supraventricular tachycardia due to atrioventricular nodal reentry by radiofrequency catheter ablation of slow pathway conduction. N Engl J Med 1992; 327: 313-318.

  23. Haissaguerre M, Gaita F, Fisher B: Elimination of atrioventricular nodal reentrant tachycardia using discrete slow potentials to guide application of radiofrequency energy. Circulation 1992; 85: 2162-2175.

  24. Iturralde P, Romero L, Colín L, Méndez A, Gutiérrez A, Hernández D, et al: Electrofulguración de una zona de preexcitación por haz de Kent. Arch Inst Cardiol Méx 1989; 59: 455-561.

  25. Colín L, Kershenovich S, Iturralde P, Dan L, Martínez Ríos MA, Casanova M, et al: Ablación de vías accesorias con radiofrecuencia en 100 pacientes consecutivos con taquicardias supraventriculares. Arch Inst Cardiol Méx. 1993; 63: 17-20.

  26. Anderson RH, Becker AE: Anatomy of the conduction tissues and accessory atrioventricular connections. In Cardiac Electrophysiology: From cell to bedside. Zipes DP, Jalife J eds. Filadelfia, WB Saunders Company, 1990; 240-248.

  27. Waller BF: Clinicopathological correlations of the human cardiac conduction system. In Cardiac Electrophysiology: From cell to bedside. Zipes DP, Jalife J eds. Filadelfia, WB Saunders Company, 1990: 249-269.

  28. Gursoy S, Chiladakis Y, Kuck H: Current status of radiofrequency ablation in the preexcitation syndromes. Herz 1992; 17: 151-157.

  29. Kuck KH, Schluter M, Geiger M, Siebels J: Radiofrecuency current catheter ablation of accessory atrioventricular pathways. Lancet 1991; 337: 1557-1561.

  30. Mont L, Schluter M, Kuck KH: Predictors of successful ablation of left sided accessory pathways using the single catheter technique. PACE 1992; 15: 590 (Abstract).

  31. Tai CT, Chen SA, Chiang CE, Lee SH, Wen ZC, Chen YJ, et al: Identification of fiber orientation in left free-wall accessory pathways: implication for radiofrequency ablation. J Interv Card Electrophysiol 1997; 1(3): 235-241.

  32. Swartz JF, Cohen AI, Fletcher RD: Right coronary epicardial mapping improves accessory pathway catheter ablation success. (Abstract). Circulation 1989; 80: (suppl II): II, 431.

  33. Josephson ME: Surgical and nonsurgical ablation in the therapy of arrhythmias. In: Clinical cardiac electrophysiology, techniques and interpretations. Josephson ME, ed. Philadelphia. Lea & Febiger, 1993; 726-821.

  34. Jackman WH, Friday KJ, Fitzgerald DM: Localization of left free wall and posteroseptal accessory atrioventricular pathways by direct recording of accessory pathway activation. PACE 1989; 12: 204-214.

  35. Kuck KH, Schluter M, Gursoy S: Perservation of atrioventricular nodal conduction during radiofrequency current catheter ablation of midseptal accessory pathways. Circulation 1992; 86: 1743-1752.

  36. Wathen M, Natale A, Wolfe K: An anatomically guided approach to atrioventricular node slow pathway ablation. Am J Cardiol 1992; 70: 886-889.

  37. Moulton K, Miller B, Scott J: Radiofrequency current catheter ablation of accessory atrioventricular pathways. Lancet 1991; 337: 1557-1561.

  38. Scheinman MM: Atrioventricular reentry lessons learned from radiofrequency modification of the node. Circulation 1992; 85: 1619-1620.

  39. Jackman WM, Beckman KJ, Mc Clelland JH: Participation of atrial myocardium (posterior septum) in AV nodal reentrant tachycardia evidence from resetting by atrial extraestimuli. PACE 1991; 14: 646-647.

  40. Langberg JJ, Chin M, Schamp DL: Ablation of the atrioventricular junction with radiofrequency energy using a new electrode catheter. Am J Cardiol 1991; 67: 142-147.

  41. Roman CA, Wang X, Friday KJ: Catheter technique for selective ablation of slow pathway in AV nodal reentrant tachycardia. (Abstract). PACE 1990; 13: 498.

  42. Wathen M, Natale A, Wolfe K, Yee R, Newman D, Klerin G: An anatomically guided approach to atrioventricular node slow pathway ablation. Am J Cardiol 1992; 70: 886-889.

  43. Ebstein LM, Coggins DL, Cohen A: Slow AV nodal pathway ablation: predictor of success and recurrence. (Abstract). Circulation 1992; 82: 521.

  44. Langberg JJ, Harvey M, Calkins H: Titration of power output during radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia. PACE 1993; 16: 465-470.

  45. Lindsay B, Chung M: Therapeutic end points for the treatment of atrioventricular node reentrant tachycardia by catheter-guided radiofrequency current. J Am Coll Cardiol 1993; 22: 733-740.

  46. Moro C, Madrid AH, Novo L, Marín E, Esteve JJ: Taquicardias intranodales. Ablación de la vía rápida y vía lenta. Rev Esp Cardiol 1993; 46: 304-312.

  47. Calkins H, Young P, Miller JM, Oishansky B, Carlson M, Saul JP, et al: Reentrant tachycardia, and the atrioventricular junction: final results of a prospective, multicenter clinical trial. The Atakr Multicenter Investigators Group. Circulation 1999; 99(2): 262-270.

  48. Nsah E, Berger R, Rosenthal L, Hui R, Ramza B: Relation between impedance and electrode temperature during radiofrequency catheter ablation of accessory pathways and atrioventricular nodal reentrant tachycardia. Am Heart J 1998; 136(5): 844-51.

  49. A consensus statement from the Cardiac Nomenclature Study Group. Working Group of Arrhythmias, European Society of Cardiology, and the Task Force on Cardiac Nomenclature from NASPE. Living, anatomy of the atrioventricular junctions. Eur Heart J 1999; 20: 1068-1075.

  50. Lesh M, Van Hare GF, Epstein LM: Radiofrequency catheter ablation of atrial arrhythmias. Results and mechanism. Circulation 1994; 89: 1074-1089.

  51. Feld GK: Catheter ablation for the treatment of atrial tachycardias. Prog Cardiovasc Dis 1995; 37: 205-224.

  52. Arribas F, López Gil M, Goicolea A, García Cossio F: Flutter auricular, mapeo ablación con radiofrecuencia. Rev Esp Cardiol 1993; 46: 510-528.

  53. Haissaguerre M, Soudi N: Role of catheter ablation for supraventricular tachyarrhythmias with emphasis on atrial flutter and atrial tachycardia. Current Opinion Cardiology 1994; 9: 40-52.

  54. Araya V, Iturralde P, Kershenovich S: Flutter auricular asociado a un aneurisma del septum interatrial sometido a la ablación con radiofrecuencia. Arch Inst Cardiol Mex 1995; 65: 245-253.

  55. Cosio FG, Arribas F, López Gil M, González HD: Atrial flutter mapping and ablation II. Radiofrequency ablation of atrial flutter circuits. PACE 1996; 19: 965-975.

  56. Lin JL, Huang SK, Lai LP, Cheng TF, Tseng YZ, Lien WP: Radiofrequency catheter ablation of septal accessory pathways within the triangle of Koch: importance of energy titration testing other than the local electrogram characteristics for identifying the successful target site. Pacing Clin Electrophysiol 1998; 21(10): 1909-1917.

  57. Jackmnan WM, Wang X, Friday KJ: Catheter ablation of atrioventricular junction using radiofrequency current in 17 patients. Comparison of Standard and large tip catheter electrodes. Circulation 1991; 18: 1753-1758.

  58. Yeung Lai Wash JA, Alison AF, Lonergan L: High success rate of atrioventricular node ablation with radiofrequency energy. J Am Coll Cardiol 1991; 18: 1753-1758.

  59. Chen SA, Tsang WP, Hsia CP: Comparison of direct current and radiofrequency ablation of free wall accessory atrioventricular pathways in the WPW syndrome. Am J Cardiol 1992; 70: 321-326.

  60. Evans GT, Scheinman MM: The executive committee of the registry. The percutaneous cardiac mapping and ablation registry. Final summary of results. PACE 1988; 11: 1621-1626.

  61. Auricchio A, Klein H, Trappe HJ, Troester J, Salo E: Effect on ventricular performance of DC shock for catheter ablation of the atrioventricular junction. PACE 1992; 15: 344-356.

  62. Huang SKS: Advances in applications of radiofrequency current to catheter ablation therapy. PACE 1991; 14: 28-42.

  63. Kay NG, Epstein AE, Dailey SM, Plumb VJ: Role of radiofrequency ablation in the management of supraventricular arrhythmias. J Cardiovasc Electrophysiol 1993; 4: 371-389.

  64. Twidale N, Beckman K, Hazlitt HA: Radiofrequency ablation of accessory pathways are the ventricular lesions arrhythmogenic. (Abstract). Circulation 1991; 84(Suppl 2): 710.

  65. Villacastin J, Almendral J, Arenal A: Ablación mediante radiofrecuencia de las vías accesorias auriculoventriculares. Rev Esp Cardiol 1993; 46(6): 367-380.

  66. Jackman WM, Kuck KH, Friday KJ: Catheter recording of accessory atrioventricular activation. In Cardiac electrophysiology: from cell to bedside. Zipes DP, Jalife J, eds. Filadelfia WB Saunders Company 1990: 491-502.

  67. Lesh MD, Van Hare G, Schamp DJ: Curative percutaneous catheter ablation usin radiofrequency energy for accessory pathway in all locations: results in 100 consecutive patients. J Am Coll Cardiol 1992; 19: 1303-1309.

  68. Becker AE: Morphologic characteristics of arrhythmias. In Cardiac arrhythmias: where to go from here. Brugada P, Wellens HJJ, eds. Mount Kisco, N.Y. Futura 1987: 33-26.

  69. Haissaguerre M, Fischer B, Warin J, Dartigues JF, Lemetayer P, Egloff P, et al: Electrogram patterns predictive of successful radiofrequency catheter ablation in accessory pathways. PACE 1992; 15: 2138-2145.

  70. Swartz JF, Tracy CM, Fletcher RD: Radiofrequency endocardial catheter ablation of accessory atrioventricular pathway atrial insertion sites. Circulation 1993; 87: 487-499.

  71. Chen SA, Chiang CE, Chiou CW, Yang CJ, Cheng CC, Wang SP, et al: Serial electrophysiological studies in the late outeome of radiofrequency ablation for accessory atrioventricular pathway mediated tachyarrhythmias. Eur Heart J 1993; 14: 734-743.

  72. Hindricks G, Borggrefe M, Haverkamp W, Karbern V, Chen X, Budde T, et al: Short and long term complication of catheter ablation using radiofrequency energy. Observation in 192 consecutive patients. (Abstract). J Am Coll Cardiol 1992; 19: 184.

  73. Borggrefe M, Seidlk K, Shenasa M, Haverkammpw, Hindricks G, Breithardt G: Incidence of atrial fibrillation after successful ablation of accessory pathway. (Abstract). J Am Coll Cardiol 1992; 19: 27.

  74. Akhtar M, Jazayeri M, Jasbir S: Atrioventricular nodal reentry: clinical, electrophysiological and therapeutics considerations. Circulation 1993; 88: 282-295.

  75. Wu D, Yeh S, Wang CC, Wen MS, Lin FC: A simple technique for selective radiofrequency of the slow pathway in atrioventricular node reentrant tachycardia. J Am Coll Cardiol 1993; 21: 1612-1621.

  76. Kalbfleisch SJ, Strickberger SA, Williamson B, Vorperian VR, Man C, Hummel JD, et al: Randomized comparison of anatomic and electrogram mapping approaches to ablation of the slow pathway of atrioventricular node reentrant tachycardia. J Am Coll Cardiol 1994; 23: 716-723.

  77. Mitrani RD, Klein LS, Hackett FK, Zipes DP, Miles WM: Radiofrequency ablation for atrioventricular node reentrant tachycardia: comparison between fast (anterior) and slow (posterior) pathway ablation. J Am Coll Cardiol 1993; 21: 432-441.

  78. Langberg JJ, Leon A, Borganelli M, Kalbfleisch SJ, el-Atassi R, Calkins H, et al: A randomized, prospective comparison of anterior and posterior approaches to radiofrequency catheter ablation of atrioventricular nodal reentry tachycardia. Circulation 1993; 87: 1551-1556.

  79. Kottkamp H, Hindricks G, Willems S, Chen X, Reinhardt L, Haverkamp W, et al: An anatomically and electrogram guided stepwise approach for effective and safe catheter ablation of the fast pathway for elimination of atrioventricular node reentrant tachycardia. J Am Coll Cardiol 1995; 25: 974-981.

  80. Feld GK, Fleck RP, Chen PS, Boyce K, Bahnson TD, Stein JB, et al: Radiofrequency catheter ablation for the treatment of human type 1 atrial flutter. Identification of a critical zone in the reentrant circuit by endocardial mapping techniques. Circulation 1992; 86: 1233-1240.

  81. Kay GN, Bubien RS, Epstein AE, Plumb VJ: Effect of catheter ablation of the atrioventricular junction on quality of life and exercise tolerance in paroxysmal atrial fibrillation. Am J Cardiol 1988; 62: 741-744.

  82. Cordero CA, Iturralde TP, Lara BS, Colìn LL, Kersenovich SS, Carvajal A: Ablación con radiofrecuencia en el tratamiento de la taquicardia ventricular. Arch Inst Cardiol Méx 1996; 66: 210-219.

  83. Calkins H, Niklason L, Sousa J, el-Atassi R, Langberg J, Morady F: Radiation exposure during radiofrequency catheter ablation of accessory atrioventricular connection. Circulation 1991; 84: 2376-2382.

  84. Bogun F, El-Atassi R, Daud E, Ching MK, Strickberg A, Morady F: Radiofrequency ablation of idiopathic left fascicular tachycardia. PACE 1995; 18: 1427-1437.

  85. Gonska BD, Cao K, Achaumann A, Dorsewski A, Muhlen F, Kreuzac H: Catheter ablation of ventricular tachycardia in 136 patients with coronary disease and long term follow up. J Am Coll Cardiol 1994; 24: 1506-1514.

  86. Tchou P, Mendirad AA: Bundle branch reentry ventricular tachycardia. PACE 1995; 18: 1427-1437.

  87. Borganelli M, El-Atassi R, Leon A, Steven J, Borganelli M, el-Atassi R, et al: Delayed cure of the Wolff Parkinson White syndrome after radiofrequency catheter ablation. (Abstract). J Am Coll Cardiol 1992; 19: 184.

  88. Lindsay BD, Eichling JO, Ambos HD, Cain ME: Radiation exposure to patients and medical personnel during radiofrequency catheter ablation for supraventricular tachycardia. Am J Cardiol 1992; 70: 218-223.

  89. Haissaguerre M, Gencel L, Fischer B, Le Metayer P, Poquet F, Marcus FI, et al: Successful catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 1994; 5: 1045-1052.




2020     |     www.medigraphic.com