射频导管消融术并发心脏压塞的临床分析

目的 通过分析射频消融术并发心脏压塞的临床特点，为预防及治疗这个并发症提供临床经验。方法 对发生心脏压塞的患者的临床资料进行回顾性分析，探讨可能的机制并提出预防措施。结果 850例接受射频消融治疗的患者中，4例发生心脏压塞。其中3例为老年患者，平均年龄67岁，1例为8岁儿童。所有患者均为左侧旁路，左前侧2例，左后侧2例。术中常规放置冠状静脉窦电极导管并经主动脉逆行插管进行射频消融，常规使用了肝素。发生心脏压塞后4例患者均给予心包穿刺，2例进行了外科开胸手术，1例经剑突下直接切开心包。术中证实2例为冠状静脉窦破裂，1例为左心室游离壁穿孔。结论 射频消融术中心脏压塞多发于左侧旁路的老年患者，冠状静脉窦破裂是最常见的原因，也与不恰当心室内导管操作及肝素使用有关。发生心脏压塞后即刻行心包穿刺是维持生命及后续治疗的必要保证。穿刺后仍不能维持血压则应尽早开放心包减压。

Clinical analysis of patients with acute cardiac tamponade during radiofrequency catheter ablation procedure

Objective To provide clinical experience in the t reatment and prevention of complicated acute cardiac tamponade in the course of radiofrequency ablation (RFCA) in patients with tachyarrhythmias.Met hod To analyse the clinical features of patients with acute cardiac tam ponade and to investigate the possible underlying mechanism.Results There were 4 (0 48%) patients complicated with acute cardiac tamponade in 850 patients undergoing RFCA Of the 4 patients,3 were more than 65 years old,th e other one was a 8- year-old child Electrophysiological study indicated t hat t he underlying mechanism of tachycardia in all the 4 patients were left-side acc essory pathways,2 were anterior and 2 posterior pathways Coronary sinus mapping catheter was routinely inserted and ablation catheter was positioned retrograde l y through aortic valve Unfractionade heparin was administered in all patients when cardiac tamponade was diagnosed,pericardiocentesis was performed Because o f the deterioration of heamodynamic condition,2 patients underwent pericardial i ncision through thoracotomy and 1 patient through xiphoid approach It was confi rmed by surgical operation that coronary sinus perforation occurred in 2 patient s and left ventricular free wall perforation in 1 patient Conclusion Cardiac tamponade as a complication of RFCA was rare However,it often oc curred in old patients with left accessory pathway The common underlying mechan ism was perforation of coronary sinus The old age of the patients and the admin istration of heprin,as well as inappropriate catheter manipulation within left v entricle may contribute to the occurrence of acute cardiac tamponade