老年心房颤动射频消融术后早期呼吸困难原因及处理策略  

Causes and treatment strategies of dyspnea early after radiofrequency ablation in elder patients with AF

作　　者：时向民[1] 李健[1] 李世兴 张闯[1] 王浩[2] Shi Xiangmin;Li Jian;Li Shixing;Zhang Chuang;Wang Hao(Department of Cardiovascular Diseases,Sixth Medical Center of Chinese PLA General Hospital,Beijing 100486,China)

机构地区：[1]解放军总医院第六医学中心心血管病医学部,北京100486 [2]解放军总医院第二医学中心心血管内科

出　　处：《中华老年心脑血管病杂志》2022年第12期1274-1278,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：国防科技创新课题(20-163-02-ZT-008-007-01)。

摘　　要：目的探讨老年心房颤动射频消融术后早期呼吸困难的原因及处理策略。方法回顾性分析在我院行射频消融术后1周内出现呼吸困难患者18例,术前LVEF>50%,其中单纯环肺静脉隔离(CPVI)15例,CPVI联合附加线消融2例,CPVI联合左心耳封堵1例。观察患者呼吸困难出现时间及治疗方法等。结果呼吸困难出现时间为术后即刻至1周,发作时均为窦性心律,心肌损伤后综合征10例,白细胞介素6明显升高(P<0.01);左心房僵硬综合征1例,E/e′=17;房间传导阻滞综合征3例,心电图下壁导联P波呈正负双相;射血分数保留的心力衰竭4例,1例一站式手术患者左心耳较大,其余3例左心房前后径明显增大(44.5±2.5)mm,术中盐水灌注量大(1.265±0.223)L。根据病因分别给予非甾类抗炎药,利尿剂及血管扩张剂后症状不同程度缓解。结论多种原因均可导致老年人心房颤动射频消融术后早期出现呼吸困难,及时诊断及治疗至关重要。Objective To investigate the etiology and treatment strategies of early onset dyspnea after radiofrequency ablation(RFA)in elder patients with AF.Methods A retrospective analysis was performed on 18 AF patients with early onset dyspnea within 1 week after RFA in our center.Preprocedural UCG revealed their LVEF>50%.Fifteen patients received simple PVI,2 patients underwent PVI plus additional lineal ablation,and 1 patient was treated with one-stop procedure(PVI+LAAO).The time of dyspnea onset and treatment were observed.Results The time of dyspnea onset ranged from immediate to 1 week after ablation in the setting of sinus rhythm.Ten cases were diagnosed as post-cardiac injury syndrome,and all of them suffered from fever,8 complicated with pleural effusion,and 5 presented with chest pain,and significant high IL-6 was observed in them(P<0.01).One case was considered as stiff left atrial syndrome,with E/e′=17.Three cases were identified as intra-atrial conduction delay syndrome with manifesting biphasic P wave in inferior leads in surface ECG.Four patients were diagnosed as HFpEF,and one of them with huge left atrial appendage underwent one-stop procedure,and the other 3 cases,with more fluid intake(1.265±0.223)L due to enlarged LA(44.5±2.5)mm,received wide antrum ablation.Dyspnea was relieved by administration of NSAIDS,diuretics and vasodilators according to different diagnoses.Conclusion Many causes contribute to the development of dyspnea early after AF ablation in elder patients.Accurate and timely identification and immediate treatment are of great essentiality.

关 键 词：心房颤动 导管消融术 呼吸困难 消炎药 非甾类 

分 类 号：R541.75[医药卫生—心血管疾病]