肥厚梗阻型心肌病经导管化学消融术中心律失常并发症及处理

目的探讨肥厚梗阻型心肌病（ＨＯＣＭ）经导管化学消融（室间隔）术中心律失常发生类型、程度、持续时间及处理措施。方法经β受体阻滞剂、钙拮抗剂治疗效果不佳的ＨＯＣＭ患者１５例（男性９例，女性６例，年龄２６～６０岁）接受导管化学消融治疗。术中严密监测心电图，记录经导管向间隔支动脉推注无水乙醇后，心律失常的发生过程及处理后的转归。结果１３例（８６．７％）患者发生心律失常并发症，７例发生两种以上类型心律失常。其中三度房室阻滞８例，完全性右束支阻滞６例，窦性心动过缓３例，频发室性早搏６例，非持续性室性心动过速２例。除１例窦性心动过缓及５例完全右束支阻滞持续时间较久外，其余的心律失常均在暂停注射无水乙醇或采取其它相应措施后数秒至２０ｍｉｎ内消失。结论导管化学消融室间隔术中心律失常发生率虽然较高，但大多持续时间短暂、程度较轻，多为可逆性，未影响患者术后疗效。

Arrhythmic complications in transcatheter chemical ablation of septum for hypertrophic obstructive cardiomyopathy

Objective To investigate the arrhythmic complications and treatment strategy of transcatheter chemical ablation of septum for hypertrophic obstructive cardiomyopathy (HOCM). MethodBZElectrocardiograms of 15 patients(male 9,female 6,age 26 to 60)were observed when absolute alcohol was injected through an inflated balloon catheter to the septal branch of left anterior descending artery,and the arrhythmic types,degree and duration were recorded. Results Arrhythmias were found among 13 cases(867%),more than 2 types of arrhythmias in 7 cases.Complete atrioventricular block(AVB)in 8 cases,complete right bandle branch block(RBBB) in 6 cases,sinus bradycardia in 3 cases,multiple ventricular extrasystoles in 6 cases,and nonsustained ventricular tachycardia in 2 cases.Arrhythmias disappeared mostly in several seconds to 20 minutes when injection was stopped or procedures of antiarrhythmia were exerted,except 1 sinus bradycardia and 5 complete RBBB which lasted longer. Conclusion Although many types of arrhythmias happened in chemical ablation procedures they were mostly reversible with short duration and not serious,implying that this method is safe and effective for management of HOCM.