心腔内超声心动图引导室性心律失常消融致心脏压塞原因分析  

Cause analysis of cardiac tamponade induced by intracardiac echocardiography-guided ventricular arrhythmia ablation

作　　者：李赛男 梁明 孙鸣宇 金志清 丁建 张萍 王祖禄 韩雅玲 Li Sainan;Liang Ming;Sun Mingyu;Jin Zhiqing;Ding Jian;Zhang Ping;Wang Zulu;Han Yaling(Department of Cardiology,General Hospital of Northern Theater Command,Shenyang 110016,China)

机构地区：[1]北部战区总医院心内科,沈阳110016

出　　处：《中华心律失常学杂志》2022年第5期450-454,共5页Chinese Journal of Cardiac Arrhythmias

基　　金：国家重点研发计划(2016YFC0900904)。

摘　　要：目的探讨心腔内超声心动图(ICE)指导室性心律失常(VA)消融致心脏压塞发生情况及可能原因。方法对2017年1月至2021年7月在北部战区总医院心内科连续行ICE引导VA消融的30例患者进行回顾性分析。分析患者的临床资料、术中心脏压塞发生率、严重程度,结合不同导管结构和手术操作特点分析心脏压塞发生的可能原因。结果30例患者,其中男18例,中位年龄52.00(23.75,59.75)岁,年龄范围12~75岁。共进行32次ICE指导VA消融,其中3次消融术中发生心脏压塞,发生率为9.38%(3/32),分别经心包穿刺抽出200、250、100 ml暗红色不凝血后症状缓解。该3例均于标测或消融过程中可见右心室内ICE导管机械刺激所致室性早搏(室早)。胸部X线下见ICE导管顶端3 mm区域不显影。结论ICE引导VA消融致心脏压塞的发生率较高。ICE导管顶端在胸部X线下不显影、ICE导管影像在系统屏幕上显像略延迟及右心室流入道和流出道心室壁较薄弱是导致心脏压塞的可能原因。Objective To investigate the incidence and causes of cardiac tamponade in intracardiac echocardiography(ICE)guided ventricular arrhythmia(VA)ablation.Methods Thirty patients underwent ICE guided VA ablation in General Hospital of Northern Theater Command from January 2017 to July 2021 were enrolled.The clinical characteristics,incidence and severity of cardiac tamponade were recorded.The possible causes of cardiac tamponade were analyzed.Results Among 32 procedures performed in 30 patients[18 male and 12 female,52.00(23.75,59.75)years old],cardiac tamponade occurred in 3 patients(9.4%,3/32).There were 200,250 and 100 ml volume of blood aspirated separately and no surgical interventions were needed.Ventricular extrasystoles caused by mechanical stimulation of the ICE catheter in the right ventricle were recorded during mapping or ablation in these 3 cases.The 3 mm tip of ICE catheter was invisible under fluoroscopy.Conclusion The incidence of cardiac tamponade in ICE guided VA ablation was relatively high.The lack of visualization of ICE catheter tip on chest X-ray,the slightly delayed visualization of ICE catheter image on CartoSound system,and weak right ventricular free wall might be the possible causes of cardiac tamponade.

关 键 词：心脏压塞 心腔内超声心动图 室性心律失常 

分 类 号：R541.7[医药卫生—心血管疾病]