Lược sử quá trình hình thành phương pháp triệt đốt rối loạn nhịp tim qua đường ống thông

Phạm Quốc Khánh; Phan Đình Phong; Trần Song Giang; Phạm Trần Linh; Lê Võ Kiên

Các tác giả

Phạm Quốc Khánh Viện Tim mạch Việt Nam - Bệnh viện Bạch Mai
Phan Đình Phong Viện Tim mạch Việt Nam - Bệnh viện Bạch Mai
Trần Song Giang Viện Tim mạch Việt Nam - Bệnh viện Bạch Mai
Phạm Trần Linh Viện Tim mạch Việt Nam - Bệnh viện Bạch Mai
Lê Võ Kiên Viện Tim mạch Việt Nam - Bệnh viện Bạch Mai

Tóm tắt

Ở thời kỳ đầu phát triển, thăm dò điện sinh lý học là một thủ thuật xâm lấn được dùng chủ yếu để chẩn đoán xác định và để tìm ra thuốc chống loạn nhịp hiệu quả nhất cho bệnh nhân (1).

Báo cáo lâm sàng đầu tiên trên thế giới liên quan đến triệt đốt rối loạn nhịp tim qua đường ống thông thực chất là một “tai nạn nghề nghiệp” trong quá trình thủ thuật thăm dò điện sinh lý học tim. Khi đó, một trong các dây thông điện cực chẩn đoán tình cờ chạm vào điện cực sốc điện trong quá trình sốc điện chuyển nhịp, và kết quả là nút nhĩ thất của bệnh nhân bị triệt đốt (2).

Năm 1982, các nhóm tácgiả Hoa Kỳ do Scheinman và Gallagher đứng đầu đã công bố các chùm ca bệnh triệt đốt nút nhĩ thất sử dụng năng lượng dòng điện một chiều (3, 4). Nhiều nghiên cứu sau đó được tiến hành nhằm cải thiện hiệu quả và nâng cao tính an toàn của thủ thuật. Các thử nghiệm này tập trung vào việc tìm hiểu hiệu quả của các nguồn năng lượng khác nhau trong triệt đốt, bao gồm sử dụng năng lượng lazer và hóa chất. Năm 1987, nhóm các nhà điện sinh lý học tim ở Đại học Munster – CHLB Đức đã báo cáo ca bệnh đầu tiên sử dụng năng lượng sóng có tần số radio (RF) để triệt đốt rối loạn nhịp tim (5). Đây là một bệnh nhân có đường dẫn truyền phụ nằm ở thành bên vòng van ba lá. Kỹ thuật này là một bước đột phá trong triệt đốt rối loạn nhịp vì nó giúp tăng được mức năng lượng đốt tối ưu đồng thời giảm tỷ lệ biến chứng thủng tim. Kết cục là năng lượng sóng có tần số radio đã trở thành nguồn năng lượng thường quy được sử dụng trong triệt đốt rối loạn nhịp tim. Sau đó, nhóm nghiên cứu Đại học Munster tiếp tục là những người đầu tiên đề xuất sử dụng phương thức triệt đốt kiểm soát nhiệt độ -là phương thức giúp nâng cao hơn nữa an toàn thủ thuật và giúp kiểm soát được mức độ tổn thương cơ tim do triệt đốt (6).

Tài liệu tham khảo

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