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Radiofrequency ablation therapy of para-Hisian arrhythmias |
LI Meijuan,HUANG Weibin |
(Department of Cardiology, Zhongshan Hospital of Xiamen University, Xiamen Fujian 361004, China) |
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Abstract Objective To summarize the types of para-Hisian arrhythmia, methods of radiofrequency ablation, and its success rate and safety. Methods We carried out a retrospective study on the type of arrhythmias, the distribution of ablation targets, and the methods, success rate and safety of ablation in patients who had undergone intracardiac electrophysiological examination and radiofrequency ablation for para-Hisian arrhythmia in our center. ResultsAmong the 3 933 patients who had undergone radiofrequency ablation, 71 cases(1.8%) of para-Hisian arrhythmia are revealed by electrophysiological examination. Among them, 13 are diagnosed with concealed atrioventricular bypass, 24 are diagnosed with dominant atrioventricular bypass (type B pre-excitation), 10 are diagnosed with atrial tachycardia, 21 are diagnosed with premature ventricular beats, and 3 are diagnosed with ventricular tachycardia. Radiofrequency ablation is guided by the Carto3 or Ensite Velocity v4.0 three-dimensional system. In the ablation of 71 patients, 14 cases are unsuccessful (In 10 cases, the surgeon gave up because the ablation was ineffective or too close to His bundle; one patient refused the operation because of his or her family’s refusal of the risk; 3 aborted the operation due to surgical complications). Seventy-one patients are followed up for an average of (32±8) months after radiofrequency ablation. One case has a recurrence of atrial tachycardia while 56 cases are successful with the ablation and the success rate is 78.9%. One case is attacked by third-degree atrioventricular block during the operation while two cases develop junctional ectopic cardiac rhythm, and thus the incidence of complication is 4.2%. Among the 56 patients with successful ablation, 36 cases (64.3%) are successful through the right side, 16 cases(28.6%) are successful through the left side, and the combined left plus right side ablation is successful in 4 cases (7.1%). ConclusionRadiofrequency ablation can be successful in a majority of patients with para-Hisian arrhythmias with reasonable safety and effectiveness.
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