穿房间隔途径左侧游离壁旁路消融致心包填塞原因分析  

Causes of Periprocedural Cardiac Perforation and Tamponade in Patients Undergoing Radiofrequency Catheter Ablation of Left Accessory Pathway: Experience From 3 Clinical Centers

作　　者：丁立刚[1] 郝杰 吉立双[3] 黄平 刘金明 刘刚[3] 华伟[1] 张澍[1] 姚焰[1] DING Ligang;HAO Jie;JI Lishuang;HUANG Ping;LIU Jinming;LIU Gang;HUA Wei;ZHANG Shu;YAO Yan(Arrhythmia Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心律失常中心,北京市100037 [2]河北医科大学第二医院 [3]河北医科大学第一医院 [4]天津泰达心血管病医院

出　　处：《中国循环杂志》2019年第10期979-983,共5页Chinese Circulation Journal

基　　金：国家重点研发计划资助(2017YFCI307800)

摘　　要：目的:分析穿房间隔途径左侧游离壁旁路消融致心包填塞的发生率及可能原因.方法:分析2014年1月~2018年12月3个中等手术量电生理中心的1332例室上性心动过速患者,其中男性723例,女性609例,中位年龄52(35~61)岁.经电生理检查证实为房室结双径路折返性心动过速、左侧旁路参与的房室折返性心动过速或右侧旁路参与的房室折返性心动过速,然后再行房室旁路或者房室结双径路消融.分析左侧旁路参与的房室折返性心动过速患者,经主动脉逆行途径或者穿房间隔途径消融左侧旁路消融过程中心包填塞发生情况及可能原因.结果:1332例患者接受1440次射频消融术.左侧旁路参与的房室折返性心动过速453(34%)例,其中经主动脉逆行140例(31%)和穿房间隔途径313例(69%).穿房间隔途径心包填塞发生3例(0.9%),靶点位置在左侧游离壁或左前游离壁.经心包穿刺引流后心包填塞症状缓解,无外科开胸修补发生.结论:左侧旁路射频消融相关的心包填塞发生率相对较低,原因可能与过度消融、机械操作损伤和误消融毗邻结构相关.Objectives: To analyze the incidence and reasons of cardiac tamponade (CT) in patients with left-sided accessory pathway ablation through transseptal approach. Methods: We analyzed the incidence, management and reasons of cardiac tamponade in 1 332 consecutive patients undergoing radiofrequency ablation (RFAs) during 2014-2018 in three clinical centers. Results: 1 440 RFAs were performed in 1 332 patients (age 52 years, interquartile range: 35-61) with supraventricular tachycardia (SVT), 453 were left-sided procedures (n =313 with transseptal access). Transaortic or transseptal approach was performed in 31% and 69% of procedures, respectively. Cardiac tamponade occurred in 3 ( 0.9%) patients, target position located left free wall or left anterior free wall. Reasons of CT were considered to be associated with excessive ablation in targets, mechanical injury , and mis-ablation of adjacent tissue ( left inferior pulmonary vein or the base of left atrial appendage). All 3 patients recovered after pericardiocentesis and there was no need to performing urgent cardiac surgery. Conclusions: Incidence of RFA-related CT in the included three clinical centers is low and significantly associated with left sided anterior-lateral accessory pathway ablation. Excessive ablation and mis-ablation of adjacent tissue (left inferior pulmonary vein or the base of left atrial appendage) may be the possible mechanisms of cardiac tamponade.

关 键 词：左侧旁路 心包填塞 房间隔穿刺 消融 

分 类 号：R541.4[医药卫生—心血管疾病]