CartoSound指导下肥厚型梗阻性心肌病射频消融治疗  

Radiofrequency ablation of interventricular septum to treat hypertrophic obstructive cardiomyopathy with CARTOSound technology

作　　者：白瑾[1] 刘书旺[1] 冯新恒[1] 冯杰莉[1] 徐昕晔[1] 徐维 陈少敏[1] 李蕾[1] 高炜[1] BAI Jin;LIU Shu-wang;FENG Xin-heng;FENG Jie-li;XU Xin-ye;XU Wei;CHEN Shao-min;LI Lei;GAO Wei(Cardiovascular Department,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院心内科、血管医学研究所,国家卫生健康委心血管分子生物学与调节肽重点实验室,分子心血管学教育部重点实验室,心血管受体研究北京市重点实验室,北京100191

出　　处：《中国心脏起搏与心电生理杂志》2021年第1期7-11,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的探讨心腔内超声(CartoSound)三维标测指导下射频消融室间隔治疗肥厚型梗阻性心肌病(HOCM)的安全性及疗效。方法在CartoSound三维标测技术指导下,对5例HOCM患者行经皮室间隔射频消融治疗,以收缩期二尖瓣瓣叶前向运动(SAM)对应的左室室间隔部位作为消融靶点,应用Smartouch盐水灌注消融电极,消融能量35~40 W,冷盐水灌注流速20 mL/min,温度43℃,贴靠压力5~10 g,每次放电时间60 s。以左室流出道(LVOT)压力阶差下降50%或SAM区域心肌活动显著减弱作为消融有效终点。比较术前、术后LVOT压力阶差变化,记录围术期并发症发生情况,评价疗效和安全性。结果术中累计消融放电15~42次,消融范围占SAM区域比值22.9%~76.6%。术后即刻LVOT压力阶差由术前(105±93.6)mmHg下降至(40.6±37.2)mmHg(P<0.001)。随访至术后6个月,患者临床症状消失,心功能改善;术后6个月室间隔厚度由术前(16.1±2.9)mm下降至(13.3±2.4)mm(P=0.115);LVOT压力阶差由术前(105±93.6)mmHg逐步下降至(94.7±71.9)mmHg(术后7日,P=0.146)、(30.72±12.9)mmHg(术后1个月,P<0.01)、(19.4±17.8)mmHg(术后6个月,P<0.01)。5例患者均未出现手术并发症。结论经心腔内超声CartoSound指导下室间隔射频消融术治疗HOCM安全、有效。Objective To evaluate the efficacy and security of radiofrequency ablation of the interventricular septum to treat hypertrophic obstructive cardiomyopathy(HOCM) with CARTOSound technology. Methods Five patients with HOCM were observed. With the guidance of intracardiac echocardiography,left ventricular chamber was reconstructed. The mitral valve systolic anterior motion(SAM) contacting septal area was annotated on the ventricular chamber and was targeted for ablation region. Ablation energy was 35-40 W,flow rate of cold brine infusion was 20 mL/min,the temperature was 43℃, Attachment pressure 5-10 g and the discharging time was 60 s per time.The left ventricular outflow tract(LVOT) gradient reduction of >50% or myocardial weakness of the SAM area was designed as therapeutic endpoint. Echocardiography examination(gradient reduction) were performed at 7 days and 1,6 months after ablation. Results Before ablation,septal thickenss was(16.1±2.9)mm,the LVOT gradient was(105± 93.6)mmHg.After 15-42 radiofrequency release,the ratio of ablation range to SAM area were 22.9%-76.6%,the LVOT gradient improved to(40.6±37.2) mmHg(P<0.001). Follow-up to 6 months after surgery,the patients′s clinical symptoms were disappeared,the heart functions were improved to class I(NYHA).The follow-up at 6 months after ablation showed that septal thickenss was(13.3±2.4)mm(P=0.115);the LVOT gradient reduced to(94.7±71.9)mmHg(7 days later,P=0.146),(30.72±12.9)mmHg(6 months later,P<0.001),(19.4±17.8)mmHg(6 months later,P<0.001).None of the five patients experienced surgical complications. Conclusion Radiofrequency ablation of the interventricular septum to treat HOCM with CARTOSound technology is effective and safe.[Chinese Journal of Cardiac Pacing and Electrophysiology,2021,35(1):7-11]

关 键 词：心血管病学 肥厚型梗阻性心肌病 心腔内超声 CartoSound 三维标测 射频消融 

分 类 号：R542.2[医药卫生—心血管疾病] R454.1[医药卫生—内科学]