心腔内超声指导的间隔射频消融术对肥厚性梗阻型心肌病的有效性及安全性分析  

Efficacy and safety of radiofrequency catheter ablation of septal hypertrophy guided by intracardiac echocardiography in hypertrophic obstructive cardiomyopathy

作　　者：郭雪原[1] 李梦梦[1] 龙德勇[1] 桑才华[1] 汤日波[1] 蒋晨曦[1] 杜昕[1] 董建增[1] 马长生[1] Guo Xueyuan;Li Mengmeng;Long Deyong;Sang Caihua;Tang Ribo;Jiang Chenxi;Du Xin;Dong Jianzeng;Ma Changsheng(Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心内科,北京100029

出　　处：《中华医学杂志》2022年第44期3549-3552,共4页National Medical Journal of China

基　　金：国家重点研发计划(2017YFC1307800);国家自然科学基金(81700299);北京市优秀人才培养项目(2017000021469G218)。

摘　　要：分析2019年3至7月首都医科大学附属北京安贞医院心内科行心腔内超声指导下的室间隔射频消融术的肥厚性梗阻型心肌病(HOCM)患者的临床资料。所有患者术前测量左心室流出道压力阶差(LVOTG)均>50 mmHg(1 mmHg=0.133 kPa),且药物控制效果不佳,经腔内超声重建相关结构后,应用盐水灌注压力导管在超声指导下放电消融。本研究共纳入HOCM患者9例,其中男6例,平均年龄(51.7±12.2)岁,所有患者均成功接受间隔射频消融术,手术时间为(152.2±31.9)min,放电时间(838.4±227.3)s;除1例患者外,其余患者术后复测LVOTG较术前有所下降(P=0.001),且均<50 mmHg;所有患者术后二尖瓣收缩期前向运动消失,无围手术期严重并发症发生;随访过程中患者LVOTG保持稳定。本研究发现心腔内超声指导的室间隔射频消融可安全有效地降低HOCM患者的LVOTG,并可产生较持久的效果。Nine patients identified as hypertrophic obstructive cardiomyopathy(HOCM)in Beijing Anzhen Hopspital who underwent ablation from March to July 2019 were included in the study.All patients had left ventricular outflow tract gradient(LVOTG)over 50 mmHg(1 mmHg=0.133 kPa)with significant symptoms despite not optimal drug therapy.Intracardiac echocardiography(ICE)was used to reconstruct septum and surrounding structures,and monitor the effect of ablation during procedure.Nine patients with HOCM were included,.of which 6 men and 3 women.The average age was(51.7±12.2)years.All patients underwent successful ablation after a mean of procedural time of(152.2±31.9)minutes and ablation time of(838.4±227.3)seconds.Except for one patients,all other patients had significant LVOTG reduction(P=0.001)within 50 mmHg after the procedure.Systolic anterior motion of the mitral valve disappeared in all patients after the procedure without major periprocedural complications.The LVOTG of these patients remained stable during follow-up.Radiofrequency ablation using ICE guidance is feasible in treating HOCM with promising efficacy and safety.

关 键 词：心肌病 肥厚性 导管消融术 心腔内超声 三维标测系统 

分 类 号：R542.2[医药卫生—心血管疾病]