Liwen术式治疗肥厚型心肌病合并完全性右束支传导阻滞的临床研究

目的Liwen术式即经胸超声心动图引导下经皮心肌内室间隔射频消融术治疗肥厚型心肌病（HCM）合并完全性右束支传导阻滞（RBBB）的病例进行临床研究，为此类患者提供新的临床治疗方案。 方法纳入2017年在空军军医大学西京医院肥厚型心肌病诊治中心接受Liwen术式治疗的梗阻性肥厚型心肌病患者，对其临床资料进行回顾性分析。在2年随访期间，采用经胸超声心动图评价患者室间隔厚度、左心室流出道峰值压力阶差等，运动负荷心动图评价患者左心室流出道峰值压力阶差和运动总时间等，12导联心电图监测患者心脏的电活动改变，心脏核磁评估心肌纤维化情况及消融范围。 结果术后2年，患者左心室流出道（LVOT）峰值压差明显降低（静息LVOT压差：从130 mmHg降至8 mmHg；运动激发后LVOT压差：从181 mmHg降至28 mmHg），室间隔（IVS）厚度变薄（前IVS厚度：从15 mm降至8 mm；后IVS厚度：从16 mm到8 mm）；纽约心功能分级从Ⅲ级降低至Ⅰ级，运动时间由6 min增加至8 min。术前心电图提示存在RBBB，术后6个月起至2年，RBBB消失。 结论Liwen术式可以有效解除LVOT梗阻的同时促使心律失常发生良性转归。

Liwen procedure for treatment of complete right bundle branch block in a patient with hypertrophic cardiomyopathy

ObjectiveTo assess the efficacy Liwen procedure in the treatment of complete right bundle branch block (RBBB) in a hypertrophic cardiomyopathy (HCM) patient to provide a new treatment for such patients. MethodsWe retrospectively analyzed the clinical data of an HCM patient who was treated by Liwen procedure on September 2017 at the Hypertrophic Cardiomyopathy Center of Xijing Hospital of Air Force Military Medical University. During 2 years of follow-up, the interventricular septum (IVS) thickness and left ventricular outflow tract (LVOT) peak gradient were measured by transthoracic echocardiography, stress-induced gradient and total exercise time were measured by stress echocardiography, cardiac electrical activity was monitored by a 12-lead electrocardiogram, and myocardial fibrosis and ablation area were examined by cardiac magnetic resonance. ResultsAt the 2-year follow-up, the patient showed significant reductions in peak LVOT gradients (resting gradient: from 130 mmHg to 8 mmHg; stress-induced gradient: from 181 mmHg to 28 mmHg) and IVS thickness (anterior IVS: from 15 mm to 8 mm; posterior IVS: from 16 mm to 8 mm). The reductions in IVS thickness and LVOT gradients were associated with improvements in the New York Heart Association class (from 3 to 1) and total exercise time (from 6 min to 8 min). Pre-procedure ECG indicated the presence of RBBB, which disappeared from 6 months after Liwen procedure. ConclusionLiwen procedure is a new technique which can effectively relieve LVOT obstruction and cause good cardiac outcome.