Klinické využití katetrové ablace pro tachykardie z oblasti sinusového uzlu

Cor Vasa 2002, 43(5):213-218

Clinical utility of catheter ablation for tachycardias from the sinus node region

Martin Fiala^*, Petr Heinc, Jan Lukl: I. interní klinika, Fakultní nemocnice, Olomouc, Česká republika

Introduction:
Tachycardias from the sinus node region represent a spectrum of arrhythmias with an unknown mechanism that may produce serious disabling symptoms. The clinical and electrophysiological characteristics, and results of catheter ablation of these tachycardias are reported.

Patients and methods:
Seven consecutive patients (6 females) aged 39.7 ± 13.9 (20-64) years underwent 10 ablation procedures for symptomatic, drug-resistant tachycardia from the sinus node region. Selective ablation of the tachycardia was the primary end-point of the procedure.

Results:
Different clinical and electrophysiological characteristics of the arrhythmia were observed. The immediate primary end-point of the ablation, elimination of abnormal fast rhythms and preservation of normal sinus rhythm, was achieved in all patients but one, who underwent complete sinus node ablation in a different procedure. All 7 patients were free of symptoms during short-term follow-up of several days after ablation. During a follow-up of 28.9 ± 6.7 (17-34) months, 3 (43%) patients have been free of symptoms (2 patients with selective ablation and 1 patient with sinus node ablation and AAIR pacemaker implantation). Three other patients reported only mild improvement in the long term and one patient did not improve in terms of symptoms at all.

Conclusion:
Selective catheter ablation of tachycardias from the sinus node region is associated with promising immediate and short-term results, but with only a moderately favorable long-term clinical outcome, probably due to a partial and temporary effect of the ablation on the epicardially located arrhythmogenic tissue. With this ablation approach, the risk of permanent damage to normal sinus rhythm is low. Despite the lower ablation success rates, mild to moderate symptomatic alleviation from symptoms may improve the quality of life and help to avoid more aggressive ablation therapy leading to pacemaker dependence.