肥厚梗阻型心肌病间隔心肌消融术后心电图变化  

Electrocardiographic findings after septal myocardial ablation in patients with hypertrophic obstructive cardiomyopathy

作　　者：姜腾勇[1] 吕强[1] 吴学思[1] 张英川[1] 贾长琪[1] 张崟[1] 

机构地区：[1]北京安贞医院心内科,100029

出　　处：《中华心律失常学杂志》2001年第4期215-218,共4页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的　探讨肥厚梗阻型心肌病 (hypertrophicobstructivecardiomyopathy ,HOCM)经皮间隔心肌消融术 (percutaneoustransluminalseptalmyocrdialablation ,PTSMA)后心电图变化临床意义。方法　 15例HOCM患者借助术中心肌声学造影技术确定靶域 ,完成间隔心肌消融术。术后利用心肌灌注显像作为回顾性定位诊断手段。随访中对比不同时间记录的心电图和动态心电图记录。结果　心肌灌注显像显示消融部位与术中心肌声学造影相吻合 ,限于前间隔 ,仅 1例心肌灌注显像示后壁显影稀疏。心电图示 1例患者Ⅲ导联新发异常Q波 ,胸前导联无新发Q波。共 3例 5次心室颤动发生。 2例植入DDD永久起搏器 ,右束支阻滞发生率 73 %。QRS时限、QT间期、QTc间期明显延长 ,SV1 +RV5值显著降低 ,这些变化并不随着靶域变薄而发生进一步变化。动态心电图记录并不增加室性心律失常。结论　PTSMA所致心律失常发生率较高 ,但并不随着间隔心肌的变薄而加重 ,仅 13%患者需要植入永久起搏器。Objective The purpose of this study is to explore the clinical significance of electrocardiographic findings after percutaneous transluminal septal myocardial ablation (PTSMA) in patients with hypertrophic obstructive cardiomyopahty(HOCM).Methods The ECG and Holter recording of 15 patients with HOCM were compared pre and post PTSMA at different times,the target region(TR) was determined by myocardial contrast echocardiography (MCE) during PTSMA and myocardial perfusion imaging(MPI) after the procedures.Results The ablated region confirmed by MCE were in consisted with that by MPI,but one associated with posterior wall local defect of MPI.Ventricular fibrillation occurred in 3 patients for 5 times.A newly abnormal Q was found in lead Ⅲ in one patient,but not on the precordial leads.DDD pacemarkes were implanted in 2 patients after the procedurs.73% of patients developed right bundle branch block.The QRS duration?QT & QTc intervals increased significantly while the amplitude of S V 1 +R V 5 decreased markedly after the procedures.However,these indexes did not change further with the thinning of target region during follow up.And the ventricular arrythemias did not increased in Holter recordings.Conclusion The arrythemias induced by PTSMA,with a higher occurrence rate,did not further exagerates with the remodeling of ventricule.13% patients required to implant DDD pacemarker and MCE application may be helpful to avoid mocardial infarction of non target region.

关 键 词：经皮间隔心肌消融术 心律失常 心电图 心肌梗死 肥厚梗阻型心肌病 PTSMA HOCM 

分 类 号：R542.2[医药卫生—心血管疾病] R540.41[医药卫生—内科学]