经导管消融治疗心肌梗死后室性心律失常的单中心长期随访结果  

Radiofrequency catheter ablation of ventricular arrhythmias after myocardial infarction:Single⁃center long⁃term follow⁃up results

作　　者：金震 王祖禄 梁明 孙鸣宇 金志清 丁建 张萍 韩雅玲 JIN Zhen;WANG Zulu;LIANG Ming;SUN Mingyu;JIN Zhiqing;DING Jian;ZHANG Ping;HAN Yaling(Dept.of Cardiology,General Hospital of Northern Theater Command,Shenyang 110016,Liaoning,China;Graduate School,China Medical University,Shenyang 110122,Liaoning,China)

机构地区：[1]北部战区总医院心内科,辽宁沈阳110016 [2]中国医科大学研究生院,辽宁沈阳110122

出　　处：《武汉大学学报（医学版）》2023年第10期1164-1170,共7页Medical Journal of Wuhan University

基　　金：辽宁省科学技术基金资助项目(编号:2020JH1/10300002)。

摘　　要：目的:探讨射频导管消融治疗心肌梗死(MI)后室性心律失常(VA)的有效性及安全性。方法:回顾性分析2003年9月至2021年3月在北部战区总医院心内科接受导管消融治疗的MI后VA的31例患者的手术资料及随访结果。结果:患者平均年龄为(61±10)岁,30例为男性,平均左室舒张末内径(59.0±7.5)mm(48~82 mm),射血分数(44.5±9.9)%(29%~58%)。7例患者术前或术后放置植入型心律转复除颤器(ICD)。23例患者为陈旧性心肌梗死(OMI)后室性心动过速(VT);8例患者为急性心肌梗死(AMI)后多形性VT和/或心室颤动(VF)电风暴。23例OMI后VT应用心脏三维标测系统行窦性心律下电压基质标测,部分病例结合VT下激动和拖带标测指导消融;8例AMI后VA电风暴主要采用标测和消融触发多形性VT或VF的室性早搏。29/31例消融后急性完全成功,1例部分成功。所有患者术中、术后未出现心包填塞等严重并发症。31例患者中,成功随访29例,中位随访时间为42(31,68.5)个月。OMI组5/21例(23.8%)复发,但在抗心律失常药物治疗下无发作或较少发作;AMI组2/8例(25.0%)VA复发,1例经再次消融成功。结论:OMI后VT和AMI后VA电风暴的电生理机制和导管消融靶点明显不同,射频导管消融是治疗OMI和AMI后VA的安全、有效方法。Objective:To evaluate the efficacy and safety of radiofrequency catheter ablation(RFCA)in the treatment of ventricular arrhythmia(VA)after myocardial infarction(MI).Methods:The RFCA and followup results of 31 patients with VA after MI from September 2003 to March 2021 were analyzed retrospectively.Results:The average age of the patients was(61±10)years old.A total of 30 patients were male.The average left ventricular enddiastolic diameter was(59.0±7.5)mm(4882 mm),and the left ventricular ejection fraction was(44.5±9.9)%(29%58%).Implantable Cardioverter Defibrillator(ICD)was implanted in 7 patients before or after ablation procedures.In the 23 patients with old myocardial infarction(OMI)and sustained monomorphic ventricular tachycardia(VT),the strategies of mapping and ablation were voltage mapping in sinus rhythm to identify the possible VT substrate,and activation mapping and/or entrainment mapping during VT were also used in some cases.In the 8 patients with acute myocardial infarction(AMI)and electrical storm(ES),the premature ventricular contractions(PVCs)triggering polymorphic VT or ventricular fibrillation(VF)were mapped and ablated.Acute complete success was achieved in 29 of the 31 patients,and acute partial success in 1 patient.No serious complications such as pericardial tamponade occurred during and after ablation procedures.The median followup time was 42(31,68.5)months in 29 patients with successful followup.VA recurred in 5 of 21 cases(23.8%)in the OMI group and 2 of 8(25.0%)patients in the AMI group.Conclusion:The electrical mechanism and ablation targets were different between OMI with VT and AMI with VA electrical storm.Catheter ablation is a safe and effective method for the treatment of VA after AMI and OMI.

关 键 词：射频导管消融 心肌梗死 室性心律失常 室性心动过速 电风暴 

分 类 号：R541.7[医药卫生—心血管疾病]