行心房颤动射频消融术的患者中房间隔膨出瘤或过度运动的合并情况及心腔内超声指引下房间隔穿刺处理方法  

Clinical Value of Intracardiac Echocardiography Guided Fluoroless Transseptal Puncture During Radiofrequency Ablation Among Atrial Fibrillation Patients With Atrial Septal Aneurysm/Hypermobile

作　　者：李鼎[1] 昃峰[1] 苑翠珍[1] 周旭 王龙[1] 段江波[1] 何金山[1] 吴寸草[1] 李学斌[1] LI Ding;ZE Feng;YUAN Cuizhen;ZHOU Xu;WANG Long;DUAN Jiangbo;HE Jinshan;WU Cuncao;LI Xuebin(Department of Cardiac Electrophysiology,Peking University People’s Hospital,Beijing(100044),China)

机构地区：[1]北京大学人民医院心脏中心心电生理室,北京市100044

出　　处：《中国循环杂志》2022年第10期1012-1015,共4页Chinese Circulation Journal

摘　　要：目的:分析我院行心房颤动(房颤)射频消融术的患者中房间隔膨出瘤(ASA)或过度运动(HB)的合并情况及此类患者在三维心腔内超声(ICE)指引下进行无射线房间隔穿刺处理的方法。方法:回顾性分析我院2019年4月至2021年4月期间行房颤射频消融术的患者中ASA或HB的合并情况、形态特点以及此类患者在ICE指引下行无射线房间隔穿刺时吸气法的成功率与合并症发生情况。结果:共203例房颤患者在ICE指引下行房颤射频消融术,发现ASA 12例(5.9%),HB 28例(13.8%),男性多见(合并ASA、HB的患者中男性分别占75.0%、67.9%)。合并ASA的患者卵圆窝平均膨出长度为(11.6±1.1)mm,HB患者卵圆窝平均摆动距离为(6.4±1.4)mm。在合并ASA或HB的患者中,在ICE指引下采用吸气法进行房间隔穿刺的成功率为100%,未出现合并症。12例ASA患者中,1例在房间隔穿刺过程中使用X线透视。结论:在行房颤射频消融的患者中,ASA或HB并不少见,此类患者在ICE指引下采用吸气法行无射线房间隔穿刺安全、有效。Objectives:To analyze the incidence of atrial septal aneurysm(ASA)or hypermobile(HB)in patients with atrial fibrillation(AF)undergoing radiofrequency ablation(RFCA)and the clinical value of fluoroless transseptal puncture(TSP)guided with intracardiac echocardiography(ICE)in these patients.Methods:The characterization and incidence of ASA/HB in the AF patients who underwent RFCA from April 2019 to April 2021 in our hospital were retrospectively analyzed,and the clinical value(success rate and complications)of ICE-guided fluoroless TSP in these patients was explored.Results:There were 12 patients(5.9%,male 75.0%)with ASA and 28 cases(13.8%,male 67.9%)with HB out of 203 patients who underwent AF RFCA in this patient cohort,all of whom received ICE-guided fluoroless TSP.The average protruding fossa ovalis(FO)length was(11.6±1.1)mm in the ASA patients and(6.4±1.4)mm in the HB patients.ICE-guided fluoroless TSP was successful in all these patients,and no complications occurred.X-ray was used in 1 patient with ASA.Conclusions:ASA/HB is not uncommon in AF patients who underwent RFCA.Fluoroless inspiration method of TSP is safe and effective for AF patients with ASA/HB.

关 键 词：心房颤动 房间隔膨出瘤 房间隔过度运动 房间隔穿刺 心腔内超声 无射线 

分 类 号：R54[医药卫生—心血管疾病]