Key result
In a 61-year-old male with sick sinus syndrome and medically refractory paroxysmal atrial flutter/fibrillation, complete atrioventricular block was successfully achieved by selective radiofrequency catheter ablation of both the fast and slow pathways.
Case Report (n=1)
No
In cases where AV junction ablation for rate control only achieves first-degree AV block via fast pathway ablation, additional selective ablation of the slow pathway can successfully create complete AV block.
May achieve complete AV block after incomplete fast-pathway ablation; hypothesis-generating and should not yet change practice.
症例は61歳男性.発作性心房粗細動を伴った徐脈頻脈症候群のためペースメーカーを植え込み, 心房粗細動に対しては薬物治療が行なわれた.ペースメーカー植え込み3年後より発作頻度が増し当院入院となった.心房粗動はcommon, uncommon typeの両者で, 心房細動も頻発し薬物抵抗性のため, 房室接合部アブレーションの適応と判断した.アブレーションカテーテルをHis束電位が最大に記録可能な部位よりわずかに後下方中隔側に引き, 高周波通電を施行した.AH間隔は110msecから400msecに著明に延長し, fast Pathwayが焼灼され, slow pathway (SP) が遺残したと考えられた.そこでSPを標的として冠静脈洞入口部近傍の高周波通電を行ない完全房室ブロック作成に成功した.完全房室ブロック作成を目的とした房室接合部アブレーションにおいて, 1度房室ブロック作成例で, SPの選択的焼灼を追加することにより完全房室ブロック作成が可能となる症例のあることが示された.
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Igawa et al. (1995) conducted a case report in Sick sinus syndrome with atrial flutter/fibrillation (n=1). Radiofrequency catheter ablation of fast and slow pathways was evaluated on Creation of complete atrioventricular block. In a 61-year-old male with sick sinus syndrome and medically refractory paroxysmal atrial flutter/fibrillation, complete atrioventricular block was successfully achieved by selective radiofrequency catheter ablation of both the fast and slow pathways.
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