左心房黏液瘤术后新发房性心律失常的患者行导管消融的有效性与安全性初探

目的初步探讨左心房黏液瘤外科术后新发房性心律失常的患者接受导管消融的安全性与有效性。方法回顾性选取北京安贞医院2014年9月至2019年11月左心房黏液瘤术后新发房性心律失常并接受导管消融治疗的患者9例。收集患者的基线临床数据、消融术中参数和围术期严重不良事件,并随访导管消融术后心律失常复发情况和临床预后,采用Kaplan-Meier生存曲线分析导管消融术后窦性心律维持率。结果9例患者年龄(55.8±9.1)岁,男性3例(3/9),阵发性心房颤动(房颤)3例(3/9),心房扑动(房扑)或房性心动过速(房速)6例(6/9)。所有患者均成功完成导管消融治疗,围术期均未发生卒中、心包积液、心脏压塞、血管并发症及大出血事件。随访40.0(27.5,55.5)个月,9例患者中有6例(6/9)初次消融术后维持窦性心律,总体窦性心律维持比例为2/3。3例房颤患者中有1例(1/3)出现早期房颤复发(术后3个月),6例房速或房扑患者中有2例(2/6)房扑患者出现极晚期新发房颤和/或复发房扑(分别为术后19、29个月)。3例复发患者中有2例接受再次消融,其中1例维持窦性心律。所有患者随访期间未复发黏液瘤,未发生死亡、卒中、急性心肌梗死等事件。结论左心房黏液瘤外科术后新发房性心律失常患者接受导管消融安全、有效,可以作为一项治疗选择。

Efficacy and safety of catheter ablation in patients with new-onset atrial arrhythmia after surgical excision of left atrial myxoma

Objective To evaluate the safety and efficacy of catheter ablation in patients with new-onset atrial arrhythmia after surgical excision of left atrial myxoma.Methods Nine patients with new onset atrial arrhythmia and a prior history of left atrial myxoma,who received surgical myxoma excision and catheter ablation between September 2014 and November 2019,were included in the present study.Baseline characteristics,procedural parameters during catheter ablation,severe perioperative adverse events,recurrence rate of arrhythmia and clinical prognosis were analyzed.Kaplan Meier survival analysis was used to define the maintenance rate of sinus rhythm after catheter ablation in this patient cohort.Results Nine patients were included.The average age was(55.8±9.1)years old(3 male),there were 3 patients(3/9)with paroxysmal atrial fibrillation(PAF)and 6 patients(6/9)with atrial flutter or atrial tachycardia(AFL or AT).Ablation was successful in all patients,there were no perioperative complications such as stroke,pericardial effusion,cardiac tamponade,vascular complications or massive hemorrhage.During a mean follow-up time of 40.0(27.5,55.5)months,sinus rhythm was maintained in six patients(6/9)after the initial catheter ablation.The overall sinus rhythm maintenance rate was 2/3.In addition,1 out of the 3 AF patients(1/3)developed recurrence of AF at 3 month after ablation,and 2 out of the 6 AFL or AT patients(2/6)developed late recurrence of AF or AFL(19 months and 29 months after ablation),two out of three patients with recurrent AFs or AFL received repeated catheter ablation and one patient remained sinus rhythm post repeat ablation.Meanwhile,there was no recurrence of atrial myxoma,no death,stroke,acute myocardial infarction and other events during the entire follow-up period.Conclusions Catheter ablation is a safe and feasible therapeutic option for patients with new-onset atrial arrhythmia after surgical excision of left atrial myxoma.