孤立性心房纤维化心肌病相关性心房颤动合并右心房静止1例  

A case of isolated atrial fibrosis cardiomyopathy-associated atrial fibrillation with right atrial standstill

作　　者：黄超群 舒尚志 李树岩[1] HUANG Chaoqun;SHU Shangzhi;LI Shuyan(Department of Cardiology,the First Hospital of Jilin University,Changchun,130061,China)

机构地区：[1]吉林大学第一医院心内科,长春130061

出　　处：《临床心血管病杂志》2022年第10期843-846,共4页Journal of Clinical Cardiology

摘　　要：心房纤维化相关性心房颤动(房颤)在临床中并不少见,但青年患者出现不明原因心房纤维化相关性房颤同时伴有右心房静止的案例罕见。对于此类患者,目前尚无明确的治疗指南,也不应完全等同于房颤的治疗策略。本文报道1例34岁青年男性患者,以胸闷6年住院治疗,既往有房颤病史,无任何已知房颤的相关危险因素,近期体表心电图发现心房无P波和完全不规整的窄QRS波,心腔内电生理检查发现右心房大片瘢痕区和低电压区,诊断为“孤立性心房纤维化心肌病、持续性房颤、持续性右心房静止”,给予抗凝和心脏射频消融术治疗后出现交界性逸搏心律,术后3个月随访房颤复发伴有交界性逸搏心律,胸闷症状未见明显改善。考虑心房纤维化心肌病是房颤和右心房静止发生发展的基础,如果单纯进行导管消融,房颤复发风险很高,消融治疗可能无效。我们认为如果在导管消融术后同时找到合适的心房起搏靶点,以维持心房正常节律,可能会取得一定的治疗效果。但如果不能找到心房起搏的合适部位,不建议常规进行导管消融术治疗。同时,该类患者无论CHADS-VASc评分如何,都应终身抗凝或行左心耳封堵术治疗。Atrial fibrosis-associated atrial fibrillation is not uncommon in clinical practice,but unexplained atrial fibrosis-associated atrial fibrillation accompanied by right atrial standstill in young patients is rare.The treatment of these patients should not be completely equivalent to the treatment of atrial fibrillation,and there are no clear treatment guidelines.We report a unique case of a 34-year-old young man with atrial fibrillation for 6 years who experienced no related complications.ECG showed no P wave and completely irregular narrow QRS waves recently.In addition,intracardiac electrophysiological examination revealed a large scar area and low voltage area in the right atrium.The patient was diagnosed with isolated atrial fibrosis cardiomyopathy,persistent atrial fibrillation,and persistent right atrial standstill.The patient underwent catheter ablation of persistent atrial fibrillation,as well as anticoagulant therapy.However,follow-up data revealed the patient’atrial fibrillation recurred and he developed a junctional escape rhythm three months after surgery.Additionally,the chest tightness has not improved.It is considered that atrial fibrosis cardiomyopathy is the basis for the occurrence and development of atrial fibrillation and right atrial standstill.If catheter ablation is performed alone,the risk of atrial fibrillation recurrence is high and ablation may be ineffective.We believe that if appropriate atrial pacing targets are found simultaneously after catheter ablation to maintain normal atrial rhythm,certain therapeutic effects may be achieved.However,if the appropriate location of atrial pacing cannot be mapped,catheter ablation is not recommended as a routine treatment.At the same time,such patients should be treated with lifelong anticoagulant therapy or left atrial appendage occlusion regardless of the CHADS-VASscore.

关 键 词：心房颤动 孤立性心房纤维化心肌病 心房静止 交界性逸搏心律 导管消融 

分 类 号：R541.7[医药卫生—心血管疾病]