无射线射频消融术治疗妊娠合并快速心律失常的疗效及安全性分析  

Efficacy and safety of catheter ablation without fluoroscopy in the treatment of pregnancy complicated with tachyarrhythmia

作　　者：包照亮[1] 李松南[2] 段娜 张豪锋[1] 龚静[1] 张军[1] Bao Zhaoliang;Li Songnan;Duan Na;Zhang Haofeng;Gong Jing;Zhang Jun(Department of Obstetrics and Gynecology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院妇产科,北京100029 [2]首都医科大学附属北京安贞医院心内科,北京100029

出　　处：《首都医科大学学报》2021年第2期204-209,共6页Journal of Capital Medical University

基　　金：北京市卫健委医疗服务与保障能力提升项目(20190542)。

摘　　要：目的探讨妊娠合并快速心律失常患者孕期行无射线射频消融手术的疗效及安全性。方法将2016年1月至2020年1月首都医科大学附属北京安贞医院收治的31例妊娠合并快速心律失常者行射频消融术,分析其疗效、安全性,并比较于不同孕期行手术的疗效和预后差异。结果①共31例患者,均为0射线在三维电磁导航标测系统下操作,27例治愈(87.1%)、3例好转(9.7%)、1例无效(3.2%)、1例复发(3.7%);治疗后心功能有明显好转(P=0.000)。②31例患者分娩时及分娩后均无心律失常再发作。③有1例自然流产、1例早产、29例孕足月分娩,平均分娩孕周(38.3±1.4)周,21例行足月剖宫产,8例阴道分娩,各孕期治疗后妊娠结局差异无统计学意义(P=0.107)。新生儿平均体质量(3280±489)g,5 min Apgar评分均为10分,无小于胎龄儿,无新生儿窒息死亡,随访1~5年幼儿均未发现生长发育异常,各孕期治疗后胎儿结局差异无统计学意义(P=0.527)。结论三维电磁导管标测系统指导下行无射线射频消融术,患者依从性好、治愈率高、复发率低,母儿预后良好,是一项治疗药物不耐受的妊娠合并持续性快速心律失常的安全有效的方式。于孕早中期或晚期行手术预后差别无统计学意义。对于术后治愈患者,心功能良好,经多学科评估无禁忌证,可阴道分娩。Objective To investigate the efficacy and safety of catheter ablation without fluoroscopy in pregnancy with tachyarrhythmia.Methods From January 2016 to January 2020,31 pregnancies with tachycardia were treated by radiofrequency ablation in Beijing Anzhen Hospital,Capital Medical University.The efficacy and safety of radiofrequency ablation were analyzed,and the differences in efficacy and prognosis were compared with those at different stage of pregnancy.Results①A total of 31 patients were treated with 0 ray under the three-dimensional electromagnetic navigation mapping system.27 patients were cured(87.1%),3 patients were improved(9.7%),1 patient was ineffective(3.2%),and 1 patient relapsed(3.7%).Cardiac function was improved significantly after treatment(P=0.000).②There was no recurrence of arrhythmia in 31 cases during and after delivery.③There were 1 case of spontaneous abortion,1 case of premature delivery,29 cases of full-term delivery.The average gestational age was(38.3±1.4)weeks,21 cases of full-term cesarean section,and 8 cases of vaginal delivery.There was no significant difference in pregnancy outcome after different pregnancy treatments(P=0.107).The average weight of the newborn was(3280±489)g.The Apgar score of the fifth minutes was 10.There was no small for gestational age infant and no neonatal asphyxia death.No abnormal growth and development was found during the follow-up of 1-5 years.There was no significant difference in fetal outcomes after different pregnancy treatments(P=0.527).Conclusion Catheter ablation without fluoroscopy guided by three-dimensional electromagnetic catheter mapping system has good compliance,high cure rate,low recurrence rate and good prognosis of mother and infant.It is a safe and effective way to treat drug intolerant sustained tachyarrhythmia.There was no significant difference in the prognosis of the operation in the middle or late trimester.For patients who were cured after operation and had good cardiac function,vaginal delivery could be performed after mu

关 键 词：快速心律失常 妊娠 无射线射频消融术 

分 类 号：R54[医药卫生—心血管疾病] R71[医药卫生—内科学]