心房颤动射频消融致心脏损伤后综合征的临床分析

目的了解心房颤动射频消融术后心脏损伤后综合征(PCIS)的易患因素及临床特点,为临床及早诊断和治疗提供依据。方法回顾性分析1 528例心房颤动射频消融术后患者,超声心动图检查确定新发心包积液和(或)胸腔积液15例,其中6例确诊为继发于心房颤动射频消融术后的PCIS。结果与无PCIS的患者比较,PCIS患者的年龄较大[(68.3±7.8)岁比(51.3±13.2)岁,t=2.180,P=0.006 2],合并高血压的比例高(83.3%比11.1%,P=0.011),且住院时间明显延长[(24.2±6.8)d比(11.4±5.5)d,t=2.896,P=0.035 7]。在6例PCIS患者中,射频消融术后均出现发热,并可探测到胸腔积液,双侧较多见(4例),单侧主要见于左侧(2例)。结论在心房颤动射频消融术后出现胸腔积液和(或)心包积液的部分患者可进一步进展成为PCIS,其中高龄或伴高血压的患者出现PCIS的可能性更大,其早期临床特点主要表现为发热和胸腔积液。     

心房颤动射频消融心房穿孔后继续消融一例

74岁起搏器术后、心房颤动(简称房颤)患者行射频消融术,常规穿刺房间隔后经鞘送入导丝不顺,造影示鞘管进入心包腔,无明显心包积液。观察15 min生命体征稳定,置换8.5F鞘为5F导管。继续15 min生命体征稳定后行消融手术,30 min后仍稳定,保留导丝在心包腔,撤出5F鞘至下腔静脉,继续完成手术后拔除鞘管及导丝,再观察半小时后送回病房。术后1 h出现心包压塞,行心包穿刺抽出150 ml积液后稳定。复查心脏彩超示少量积液。术后1个月随访未诉不适。     

心房颤动射频消融术后发生心脏损伤后综合征一例

正1临床资料女性患者,63岁,患阵发性心房扑动(房扑)、心房颤动(房颤)3年,因发作频繁于2016-09-06入院。入院后在局麻下行射频消融术,实施肺静脉隔离及三尖瓣峡部消融。术后床旁超声心动图检查无心包积液。返回病房30 min后,患者出现冷汗、心悸、胸闷、憋气,血压测不到。床旁超声心动图显示心包积液(中量)。立即行心包穿刺术,抽出暗红色血液约200 ml,血压升至100/70 mmHg(1 mmHg=0.133 kPa),     

持续性心房颤动患者经导管心脏射频消融术后并发Takotsubo综合征1例

<正>Takotsubo综合征(TTS)又称应激性心肌病、心尖球囊样综合征、心碎综合征,是一种因精神刺激或躯体应激诱发的一过性心室扩大及心室局部收缩障碍,同时伴有心电图动态改变为特征的临床综合征,酷似急性心肌梗死,但冠状动脉(冠脉)造影显示没有阻塞性冠状动脉粥样硬化性心脏病(冠心病)或急性斑块破裂的证据^[1]。     

临时起搏电极穿孔致心脏损伤后综合征一例

患者男,67岁,主因＂突发胸闷大汗5 h＂入院。既往否认高血压病、糖尿病病史。入院查体：血压90/60 mmHg（1 mmHg=0.133 kPa）,双肺呼吸音清,未闻及干湿啰音,心率40～50次/min,未闻及病理性杂音。心电图：三度房室传导阻滞,心率49次/min,Ⅱ、Ⅲ、aVF、V7～V9导联ST段抬高（图1）。血常规：血红蛋白（Hb）128 g/L,血小板130×10^9/L。     

老年人心房颤动导管射频消融并发心脏压塞的临床分析

目的 探讨年龄与房颤导管消融并发心脏压塞之间的关系.方法 回顾性收集2013年1月至2016年12月在北京安贞医院行首次房颤导管射频消融术的患者,收集其围术期临床资料,分为老年组(≥60岁)和非老年组(＜60岁),利用回归模型分析老年与房颤消融心脏压塞发生的关系.结果 本研究共纳入患者5 313例,发生心脏压塞41例(...     

心房颤动射频导管消融治疗

心房颤动是一种常见的快速性心律失常。65岁以上人群发病率约为6％,85岁以上则接近10％。随着我国人口逐步老龄化,心房颤动疾患的社会负担将加重。据流行病学调查,我国目前该病患者总数约800万。心房颤动通常不是一种恶性心律失常,但可导致中风和心力衰竭等并发症。与正常同龄人相比,该病患者的中风机会增加50％～70％。     

心房颤动导管消融致失血性休克一例

心房颤动（atrial fibrillation,AF）是常见心律失常,发病率高,预后较差[1].三维电磁导管标测（Carto）系统指导下的导管消融术,可根治或减少心房颤动发作,改善患者生活质量,降低病死率及并发症发生率[2].随着消融技术的不断进步,术者操作经验的积累,手术成功率逐步提高,并发症发生率逐渐降低,严重出血并发症发生率减少[3].2013年10月,内蒙古医科大学鄂尔多斯临床学院发生心房颤动导管消融术后,股静脉穿刺部位渗血致失血性休克一例,现报道如下.     

心房颤动射频导管消融现状

心房颤动的复律可以通过使用抗心律失常药物、电复律以及射频导管消融,在维持窦性心律方面射频导管消融则更为有效。目前,心房颤动射频导管消融术治疗仍存在较大争议。虽然肺静脉隔离是心房颤动消融的基础,但为了提高窦性心律的维持,其他消融靶点也在评估当中,尤其是对于慢性心房颤动患者。以前广泛的消融策略已用于持续性心房颤动患者,最近的一项试验显示,不增加其他部位消融的单纯肺静脉隔离术效果与更广泛消融的结果类似,这提示需要开发新的消融策略以提高窦性心律的维持率。     

导管射频消融治疗心房颤动

心房颤动发生与维持机制研究的深入使导管射频消融治疗房颤逐步进入临床。为提高导管消融治疗的成功率 ,仍有许多问题亟待解决。作者就此作一综述。     

Incidence and clinical characteristics of postcardiac injury syndrome complicating cardiac perforation caused by radiofrequency catheter ablation for cardiac arrhythmias

Background

Postcardiac injury syndrome (PCIS) is a complication of a variety of cardiac injuries, of which small heart perforation is the etiology that is often unrecognized. We reported a series of patients with PCIS secondary to cardiac perforation during catheter ablation procedures.

Methods and results

Out of 1728 radiofrequency catheter ablation procedures, 21 patients (1.2%) were complicated by echo-defined cardiac perforation not requiring surgical intervention. Among them, 6 patients (6/21, 28.6%) were diagnosed with PCIS secondary to cardiac perforation because they also developed pleural effusions (6/6, 100%) and fever (4/6, 66.7%) in addition to pericardial effusion/tamponade. Four patients with PCIS (4/6, 66.7%) and four patients without PCIS (4/15, 26.7%) underwent pericardial drainage but the drainage volume during the first 24 h was not significantly different (441.3 ± 343.9 mL vs. 182.5 ± 151.3 mL, P = 0.248). In the 6 PCIS patients, pleural effusion was detected from 3 h to 4 days (median: 2 days) after ablation procedure, predominantly bilateral (66.7%) or left-sided if unilateral. Patients with PCIS were older (64.8 ± 7.3 years vs. 45.9 ± 14.8 years, P = 0.0078), were more likely accompanied by hypertension (66.7% vs. 6.7%, P = 0.0114) and had a prolonged hospital stay (34.2 ± 15.8 days).

Conclusions

More than 25% of patients with small cardiac perforation during catheter ablation may develop PCIS which can be masked by pericardial effusion/tamponade. This kind of PCIS is more likely associated with elder or hypertensive patients and is usually characterized by early onset of pleural effusion.     

Prevention of esophageal thermal injury during radiofrequency ablation for atrial fibrillation

Pulmonary vein isolation using radiofrequency ablation is an effective therapy in patients with atrial fibrillation. However, the esophagus descends in close proximity to the posterior wall of the left atrium and renders this structure susceptible to thermal injury. Esophageal ulceration has been hypothesized to be a precursor to left atrial-esophageal fistula, a procedural complication associated with poor prognosis. In this review, we have analyzed and summarized the published data regarding esophageal thermal injury during catheter ablation for atrial fibrillation and strategies to minimize risk of this complication. While esophageal temperature monitoring can be useful, multiple factors such as patient characteristics and specific strategies for radiofrequency energy delivery also merit consideration.     

Left atrial radiofrequency ablation during cardiac surgery in patients with atrial fibrillation

Introduction: Intraoperative left atrial radiofrequency (RF) ablation recently has been suggested as an effective surgical treatment for atrial fibrillation (AF). The aim of this study was to verify the outcome of this technique in a controlled multicenter trial. Methods and Results: One hundred three consecutive patients (39 men and 65 women; age 62 ± 11 years) affected by AF underwent cardiac surgery and RF ablation in the left atrium (RF group). The control group consisted of 27 patients (6 men and 21 women; age 64 ± 7 years) with AF who underwent cardiac surgery during the same period and refused RF ablation. Mitral valve disease was present in 89 (86%) and 25 (92%) patients, respectively (P = NS). RF endocardial ablation was performed in order to obtain isolation of both right and left pulmonary veins, a lesion connecting the previous lines, and a lesion connecting the line encircling the left veins to the mitral annulus. Upon discharge from the hospital, sinus rhythm was present in 65 patients (63%) versus 5 patients (18%) in the control group (P < 0.0001). Mean time of cardiopulmonary bypass was longer in the RF group (148 ± 50 min vs 117 ± 30 min, P = 0.013). The complication rate was similar in both groups, but RF ablation‐related complications occurred in 4 RF group patients (3.9%). After a mean follow‐up of 12.5 ± 5 months (range 4–24), 83 (81%) of 102 RF group patients were in stable sinus rhythm versus 3 (11%) of 27 in the control group (P < 0.0001). The success rate was similar among the four surgical centers. Atrial contraction was present in 66 (79.5%) of 83 patients in the RF group in sinus rhythm. Conclusion: Endocardial RF left atrial compartmentalization during cardiac surgery is effective in restoring sinus rhythm in many patients. This technique is easy to perform and reproducible. Rare RF ablation‐related complications can occur. During follow‐up, sinus rhythm persistence is good, and biatrial contraction is preserved in most patients. (J Cardiovasc Electrophysiol, Vol. 14, pp. 1289‐1295, December 2003)     

Outcomes after cardiac perforation during radiofrequency ablation of the atrium

BACKGROUND: Perforation during catheter procedures in either the atrium or ventricle is relatively uncommon, but potentially fatal if tamponade ensues. This study analyzes the occurrence and outcomes of cardiac perforation during catheter-based radiofrequency ablation procedures in the left atrium. METHODS: All patients with a periprocedure perforation who have undergone radiofrequency ablation for atrial fibrillation (AF) or tachycardia were included. RESULTS: Of 632 procedures performed from January 1999 to October 2004, 15 (2.4%) were complicated by perforation requiring pericardiocentesis. The perforation site was left atrium in 9 (60.0%), right atrium in 1 (6.7%), and right ventricle in 5 (33.3%). Intracardiac echocardiography was used in 13 (86.7%) and revealed an effusion before overt instability in 11 (73.3%). Thirteen (86.7%) patients developed a blood pressure <60 mmHg. The pressure stabilized in all patients after pericardiocentesis (hypotension to intervention: 10.1 +/- 5.1 minutes). The total blood volume removed was 848 +/- 880 mL (left atrium/right atrium: 1,074 +/- 1,002 vs right ventricle: 396 +/- 266, P = 0.168). Two patients required surgery to close left atrium dome perforations. The ablation was completed in 7 (46.7%) patients. Ten (66.7%) later developed early reoccurrence of AF. All patients were neurologically intact at hospital discharge. During a 1.5 +/- 1.1 year follow-up, AF was eliminated (n = 4) or controlled (n = 1) in 5 (71.4%) patients with complete procedures, and 2 (20.0%) patients underwent successful repeat ablation. CONCLUSION: The incidence of perforation during ablation of the left atrium is low. Most perforations occur in the left atrium; however, few require surgical closure. Although less than with uncomplicated procedures, the majority of patients with complete ablations achieve long-term elimination of AF.     

心脏直视手术同期双极射频消融迷宫术治疗心房颤动

目的:探讨心内直视下同期双极射频消融治疗器质性心脏病合并心房颤动的经验及疗效.方法:2008年12月至2010年2月间采用Cardioblate<,TM>冲洗式双极射频消融机为21例器质性心脏病(19例为风湿性瓣膜病、2例为先天性心脏病)合并心房颤动患者施行消融术,其中持续性/永久性房颤17例,阵发性房颤4例,消融经线...     

阵发性心房颤动射频消融术后并发食管溃疡伴穿孔一例

射频消融是阵发性心房颤动的主要治疗方法之一,术后可引起消化道损伤,多数损伤可在10 d内自愈,但部分较深损伤难以愈合,严重者可形成心房食管瘘,威胁生命,而食管溃疡被认为可能是导致心房食管瘘的最初损伤,但由于其发生率较低,治疗经验少。本文报道1例阵发性心房颤动患者射频消融术后并发食管溃疡并穿孔患者,经药物治疗后最终痊愈,为临床此类患者的处理提供参考和借鉴。     

Long-term follow-up after radiofrequency catheter ablation for atrial fibrillation

Aims: Data on long-term follow-up of patients who have undergone catheterablation for atrial fibrillation (AF) are very limited. Thisreport aimed at presenting clinical outcome and AF-free survivalafter pulmonary vein (PV) isolation over an extended (>3years) follow-up period. Methods and results: Thirty-nine patients subjected to PV isolation for paroxysmalAF were followed-up for at least 3 years according to a strictprotocol. Fourteen patients (35.8%) had one, 19 patients (50%)had two, and 6 patients (15.4%) had three ablation procedures.At end of follow-up (42.2 ± 6.0 months), 17 patients(43.5%) were completely free of AF or other atrial arrhythmia,and 26 patients (66.6%) had symptomatic improvement. The long-termsuccess rate was 21.4% for patients subjected to a single ablationprocedure, 52.6% for patients subjected to two catheter ablationprocedures, and 66.7% for patients who underwent three ablationprocedures (P = 0.094). There was also a trend for patientswho underwent a combination of different ablation procedures(ostial, antral, and/or circumferential) to have a higher AF-freesurvival when compared with patients subjected to the same procedure(P-value for log-rank test = 0.036). Conclusion: Catheter ablation does not eliminate paroxysmal AF in up to56% of patients in the long term, despite the use of two orthree ablation procedures in two-thirds of them. However, itconfers symptomatic improvement in 67% of treated patients.     

Fossa ovalis radiofrequency perforation in a difficult case of conventional transseptal puncture for atrial fibrillation ablation

A 65-year-old man was referred for atrial fibrillation ablation to our center. Routine pre-procedure transthoracic and transoesophageal echocardiography and cardiac computed tomography examinations showed a normal interatrial septum and fossa ovalis anatomy. Access to left atrium was initially planned using a conventional transseptal needle puncture. During the procedure, several consecutive attempts in conjunction with intracardiac echocardiography support, failed to cross the septum. The procedure was then successfully carried out using a specifically designed radiofrequency transseptal catheter.