经导管射频消融治疗肥厚性心肌病合并心房颤动的初步经验

目的报道经导管射频消融治疗肥厚性心肌病（HCM）伴心房颤动（房颤），并对其可行性、安全性、有效性进行评价。方法回顾性分析2006年8月至2008年10月期间因HCM伴房颤且药物治疗效果较差至南京医科大学第一附属医院行经导管射频消融治疗的患者临床资料。患者均接受三维标测系统（Carto或EnSite—NavX）导航下环肺静脉消融术达到同侧肺静脉隔离，对持续性房颤再行左心房碎裂电位消融以及线性消融。消融术后3个月内继续服用抗心律失常药物，并于消融术后1、3、6个月行动态心电图检查，出现症状后立即行常规心电图，随访治疗效果。结果共11例HCM患者行射频消融术，年龄（52±17）岁，女性2例。其中6例为阵发性房颤，5例为持续性房颤。经导管射频消融后4周有1例因急性左心功能不良死亡，其余10例有4例复发，其中2例再次接受消融术。随访（14±10）个月，共有7例维持窦性心律，总成功率64％，未发生消融术相关的严重并发症。维持窦性心律者左心房内径及射血分数变化差异无统计学意义（46±4）mmVS（46±4）mm，0．64±0．05VS0．66±0．04，P〉0．05]，心功能改善（2．0±0．7VS1．2±0．4，P〈0．05，NYHA分级）。结论本文结果提示射频消融治疗HCM伴房颤安全且有效，术后维持窦性心律者心功能得到显著改善。

Radiofrequency catheter ablation of atrial fibrillation in patients with hypertrophic cardiomyopathy

Objective To evaluate radiofrcquency catheter ablation for treatment of atrial fibrillation (AF) in hypertrophic cardiomyopathy patients as well as its feasibility, safety and efficacy. Methods Data from patients with AF and hypertrophic cardiomyopathy who underwent radiofrequency catheter ablation (RF-CA) were retrospectively analyzed. All cases underwent circumferential pulmonary vein ablation to reach the endpoint of electrical isolation guided by three dimensional mapping system (Carto or EnSite-NavX). Patients with persistent AF also accepted additional complex fractionated atrial electrograms ablation and linear ablation in the left atrium. After the procedure, all antiarrhythmic drugs were continued in the first three months. Pa-tients were followed with 24-hour Hoher monitoring at 1,3, and 6 months after the procedure and 12-lead elec-trogram was recorded during palpitation symptoms occurred. Results Six cases were with paroxysmal AF and the other 5 were persistent (mean age 52±17 years,2 female). One patient died from acute heart failure due to atrial tachycardia attacked four weeks after the procedure. After a mean follow-up of (14±10) months, 4 of the remaining 10 patients experienced recurrence of AF, 2 of them were referred for the second catheter ablation procedure. By the end of follow-up, 7 cases were in sinus rhythm (64%). No major periprocedural com-plication occurred. There were no significant difference in left atrium diameter and left ventricle ejection fraction (46±4)mm vs (46±4) mm,0.64±0.05 vs 0.66±0.04, P> 0.05] before and after the procedure. Whereas the heart function showed marked improvement (2.0±0.7 vs 1.2±0.4, P<0. 05, the New York Heart Asso-ciation class) in patients who maintained sinus rhythm. Conclusion RFCA treatment was safe and effective for AF in the setting of hypertrophic cardiomyopathy and those who have good maintenance of sinus rhythm will ex-perience a marked improvement in heart function.