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药物治疗无效的室上性快速心律失常(SVTA)为一治疗难题.作者比较外科冷冻法和导管电灼法造成完全性房室传导阻滞(AVB)以治疗83例顽固性SUTA病人之优势.1975～1984年间,外科冷冻法治疗42例(组Ⅰ).采用Sealy技术,正中劈开胸骨,在体外循环下切开右房,标测希氏束位置;用一氧化氮致冷探头局部降温至0℃,造成暂时性AVB;复温后若房室传导恢复,再用致冷探头造成不可逆的完全性AVB;同时安装永久性心外膜起搏器.1981～1985年间,导管电灼法治疗41例(组Ⅱ).采用Gallagher技术,插入三极导管记录希氏束电图(和右房电图),选择最佳位置经标准电极导管以200～400焦耳的能量电灼造成完全性AVB.如果48小时后完全性AVB持续存在,则经静脉安装永久性起搏器.不管哪种
Drug-ineffective supraventricular tachyarrhythmia (SVTA) is a treatment challenge.The authors compared the advantages of surgical cryotherapy and catheterization in the treatment of complete atrioventricular block (AVB) in 83 patients with refractory SUTA. From 1975 to 1984, 42 cases were treated by surgical freezing (group Ⅰ) .Sealy technique was used to split the sternum in the middle and incise the right atrium under cardiopulmonary bypass. The location of His bundle was measured. The nitric oxide cooling probe was used for local cooling To 0 ℃, resulting in a temporary AVB; after rewarming if atrioventricular conduction recovery, and then caused by the cold probe irreversible complete AVB; at the same time to install a permanent epicardial pacemaker from 1981 to 1985, catheter electrocautery Treatment of 41 cases (group Ⅱ). Gallagher technology inserted into the three-pole catheter recording His bundle (and right-sided electrogram), select the best position by standard lead catheter with 200 ~ 400 joules of energy cauterization complete AVB. If complete AVB persists after 48 hours, install a permanent pacemaker intravenously.