超声引导下经皮心肌内室间隔射频消融术治疗梗阻性肥厚型心肌病不增加心律失常风险:小样本一年随访研究  

Treatment of hypertrophic obstructive cardiomyopathy by percutaneous intramyocardial septal radiofrequency ablation does not increase arrhythmia risk:a 1-year follow-up study of 35 cases

作　　者：拓胜军 刘丽文[1] 周梦垚 左蕾 张建蕾 李静[1] 王静 李晓娟 张威 胡芮 Ta Shengjun;Liu Liwen;Zhou Menyao;Zuo Lei;Zhang Jianlei;Li Jing;Wang Jing;Li Xiaojuan;Zhang Wei;Hu Rui(Department of Ultrasound,the First Affiliated Hospital of Air Force Medical University(Xi'jing Hospital),Hypertrophic Cardiomyopathy International Cooperation Center,the First Affiliated Hospital of Air Force Medical University(Xi'jing Hospital),Multidisciplinary Consultation Center of Hypertrophic Cardiomyopathy,Shaanxi Province,Multidisciplinary Clinic and Genetic Counseling Center of Hypertrophic Cardiomyopathy,Xijing Hospital,Xi'an 710032,China;Department of Ultrasound,Yan′an People′s Hospital,Yan′an 716000,China.)

机构地区：[1]解放军空军军医大学第一附属医院(西京医院)超声医学科,解放军空军军医大学第一附属医院(西京医院)肥厚型心肌病国际合作中心,陕西省肥厚型心肌病多学科会诊中心,西京医院肥厚型心肌病多学科诊治与遗传咨询中心,西安710032 [2]延安市人民医院超声诊断科,716000

出　　处：《中华医学超声杂志（电子版）》2020年第5期416-420,共5页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：国家科技部国际合作专项(2014DFA31980);国家科学自然基金(81671693,81601498);陕西省重点项目(2017ZDXM-SF-058);西京医院新技术、新业务资助项目(417432A)。

摘　　要：目的探讨24 h动态心电图评估超声引导下经皮心肌内室间隔射频消融术(PIMSRA,Liwen术式)治疗梗阻性肥厚型心肌病(HOCM)致心律失常风险。方法选取2016年6月至2018年7月在西京医院行Liwen术式治疗HOCM患者35例,分别在Liwen术式治疗HOCM术前以及术后1年,采用24 h动态心电图获取室性心律失常、房性心律失常以及心率变异性参数,采用配对样本t检验和配对Wilcoxon符号秩和检验比较术前和术后上述参数的变化。结果消融前后最大心率、最低心率、平均心率,差异均无统计学意义(P均>0.05);室性早搏总数、成对室性早搏总、多源室性早搏以及Lown′s分级,差异均无统计学意义(P均>0.05);消融前后室上性早博总数、成对室上性早博总数、室上性心动过速总数,差异均无统计学意义(P均>0.05);消融前后最大QT以及最大QTc无显著变化,差异均无统计学意义(P均>0.05);消融前后心率变异性参数,差异均无统计学意义(P>0.05)。结论Liwen术式治疗HOCM不增加术后短期心律失常风险,其远期风险需要大样本长期观察。Objectives To evaluate the risk of arrhythmia in patients with hypertrophic obstructive cardiomyopathy(HOCM)treated by echocardiography-guided percutaneous intramyocardial septal radiofrequency ablation(PIMSRA)with 24-hour Holter.Methods Before and 1 year after PIMSRA,the parameters of ventricular arrhythmia,atrial arrhythmia,and heart rate variability were obtained by 24-hour Holter.The difference of these parameters before and after operation were compared by paired sample t test and paired Wilcoxon signed rank sum test.Results There was no significant difference in heart rate,ventricular arrhythmia,or supraventricular arrhythmia before and 1 year after PIMSRA(P>0.05).Maximum QT and maximum QTc did not differ significantly between before and 1 year after PIMSRA(P>0.05).There was also no significant difference in heart rate variability before and 1 year after PIMSRA(P>0.05).Conclusion PIMSRA does not increase the risk of short-term arrhythmia in patients with HOCM.Further study in a large number of patients is needed for assessing long-term risk.

关 键 词：梗阻性肥厚型心肌病 经皮心肌内室间隔射频消融术 24小时动态心电图 

分 类 号：R542.2[医药卫生—心血管疾病]