射频导管消融治疗快速心律失常并发急性心脏压塞的原因分析

目的　分析射频导管消融快速心律失常并发急性心脏压塞的原因。方法　 1996年 1月至 2 0 0 3年 8月对 63 90例快速心律失常患者进行了射频导管消融术 ,男性 3 598例、女性 2 792例 ,17例并发急性心脏压塞 ,采用造影剂与X线指示下心包穿刺引流术处理 ,无效时采用外科手术。结果急性心脏压塞发生率为 0 2 7% (17/ 63 90 ) ,男性 4例、女性 13例 ,女性患者占 76 47% (13 / 17) ;女性急性心脏压塞发生率为 0 46% (13 / 2 792 )、男性急性心脏压塞发生率为 0 11% (4/ 3 598) ,P <0 0 1;17例急性心脏压塞中的 10例 (58 82 % )因经主动脉逆行途径消融左侧旁路 (其中 9例是隐匿性旁路 )时导管机械性损伤导致左心室穿孔引起。所有病例均经剑突下途径进行造影剂和X线指示下心包穿刺引流术 ,其中 13例经心包穿刺引流后症状完全缓解 ,无继续出血 ,4例引流后仍继续出血或引流不成功而行外科手术修补成功。急性心脏压塞处理总成功率为 10 0 % (17/ 17) ,病死率为 0。结论　 (1)射频导管消融快速心律失常并发急性心脏压塞多见于女性 ;(2 )发生急性心脏压塞患者的快速心律失常机制以左侧隐匿性旁路多见 ,穿孔部位以左心室多见 ;(3 )造影剂和X线指示下心包穿刺引流术是急性心脏压塞快速有效的处理方法 ,可使多数患者

Risk factors and causes of acute cardiac tamponade complicating radiofrequency catheter ablation for tachyarrhythmias

Objective To identify the risk factors and ca us es of acute cardiac tamponade complicated during radiofrequency catheter ablatio n procedure of tachyarrhythmias. Methods Radiofrequency catheter ablations were performed in total 6 390 patients with tachyarrhythmias from Jan . 1996 to Aug. 2003 (3 598 male, 2 792 female). Among them, 17 cases were comp licated with cardiac tamponade and each was managed by percutaneous pericardial drainage (PPD) guided by pericardial cavity radiography, surgical procedure wa s done when PPD failed. Results Total incidence of acute cardiac tamponade was 0 27%(17/6 390), and 76 47%(13/17) of them were female. The incidence of ca rdiac tamponade in female patients is much higher than that in male (0 46% vs 0 11%, P <0 01). Ten cases of cardiac tamponade were due to lef t ventricular perforation caused by mechanical injury during ablating left-side d accessory pathway (9 of them were concealed left-sided accessory pathway). PPD was carried out in each of the 17 cases guided by pericardial cavity radiogr aphy. In 13 of them, no active bleeding was noticed after PPD (catheter indwelled in 10 patients, drawing via a needle in 3 c ases). Surgical management was needed in remaining 4 cases (3 were due to acti ve bleeding, one was due to ineffective PPD). Acumulative successful rate was 1 00% for management of cardiac tamponade. Conclusions (1)Cardia c tamponade is more likely to occur in female patients, and it is most commonly seen in patients with concealed left-sided accessory pathway. Left ventricular perforation was the major cause of cardiac tamponade; (2)Though PPD guided by pericardial cavity radiography is an effective way to manage cardiac tamponade, surgical back-up is necessary when doing percutaneous radiofrequency catheter a blation.