心律失常射频导管消融术中心包填塞的发生率、原因及处理策略分析

目的:分析心律失常射频导管消融术中心包填塞的发生率、原因及处理转归,探讨更有效的预防及处理措施。方法:回顾分析我院心律失常中心2016年1月至2018年12月实施射频导管消融术患者共2211例,其中15例(0.68%)发生心包填塞。分析心包填塞发生率、原因及处理转归情况。结果:2211例射频导管消融的患者中,934例室上性心动过速患者中无心包填塞;707例房性心律失常患者中有10例(1.41%)发生心包填塞,其中9例是使用非压力导管导致术中出现心包填塞;570例室性心律失常患者中有5例(0.88%)发生心包填塞。根据消融过程及开胸结果,12例可确定心脏穿孔位置,分别在右心室流出道(RVOT)游离壁3例、左心房顶部4例、右心室心尖部2例及其他位置3例。术中及时心包穿刺引流,9例患者顺利拔除心包引流管,6例需要外科开胸手术,所有患者经抢救后均恢复良好,无死亡病例发生。结论:心律失常射频导管消融术中心包填塞发生率较低,其发生率与房性心律失常消融、操作损伤及有无压力监测相关。此外与特定解剖部位(比如RVOT游离壁、左心房前顶部等)局部薄弱或导管难以稳定贴靠导致过度消融相关。心包填塞大多经心包穿刺引流后预后良好。

Incidence,Causes and Management Strategies of Pericardial Tamponade During Catheter Ablation for Arrhythmia: A Single Center Experience

Objectives:To analyze the incidence,risk factors,and outcome and to explore more effective prevention and treatment options of pericardial tamponade during catheter ablation for arrhythmia.Methods:A total of 2211 patients who underwent catheter ablation from January 2016 to December 2018 in the Arrhythmia Center of our hospital were retrospectively analyzed.15 of these patients(0.68%)developed pericardial tamponade.Results:A total of 2211 patients undergoing catheter ablation for arrhythmias,including 934 supraventricular tachycardia,707 atrial arrhythmia and 570 ventricular arrhythmia,were enrolled in this analysis.10(1.41%)cases of pericardial tamponade occurred in ablation for atrial tachycardia,non-pressure catheter was used in 9 out of 10 cases.5(0.88%)cases of pericardial tamponade occurred in ablation for ventricular arrhythmia.According to the ablation process and the results of thoracotomy,12 cases of cardiac perforation could be located,3 in the free wall of RVOT,4 in the top of left atrium,2 in the apex of right ventricle and 3 in the other site respectively.Pericardial drainage were performed in all 15 patients and 9 patients recovered and thoracotomy was required in 6 patients.All patients recovered well after above treatments and no death occurred.Conclusions:The incidence of pericardial tamponade during catheter ablation is low,which is related to atrial arrhythmia ablation,operative injury,absence or presence of pressure monitoring.In addition,it is related to the anatomical sites(such as RVOT free wall,anterior left atrial top,etc.),in these locations,the myocardium is very thin,which make the attachment of the ablation catheter to these sites very difficult and may result in excessive ablation.Generally,the prognosis of patients with pericardial tamponade is satisfactory after timely pericardial puncture and drainage or surgical treatment.