无水乙醇注射Marshall静脉消融二尖瓣峡部的效果观察  

Effect of the vein of Marshall ethanol infusion in mitral isthmus ablation

作　　者：张东亚[1] 胡晓峰[2] 姜伟峰[2] 秦牧 刘旭[2] ZHANG Dongya;HU Xiaofeng;JIANG Weifeng;QIN Mu;LIU Xu(Department of Cardiology,Nantong Third People′s Hospital,Jiangsu 226006;Department of Cardiology,Shanghai Chest Hospital)

机构地区：[1]南通市第三人民医院心血管内科,江苏226006 [2]上海市胸科医院心血管内科

出　　处：《南通大学学报（医学版）》2024年第1期24-27,共4页Journal of Nantong University(Medical sciences)

基　　金：南通市市级科技计划(指导性)项目(MSZ18075)。

摘　　要：目的:评估无水乙醇注射Marshall静脉(vein of Marshall,VOM)在持续性心房扑动(简称房扑)、心房颤动(简称房颤)二尖瓣峡部线性消融中的有效性和安全性。方法:收集2019年9月—2020年5月上海市胸科医院采用射频消融+无水乙醇注射VOM治疗持续性房扑、房颤患者72例(VOM组)的临床资料,同时选择采用左房线性消融治疗持续性房扑、房颤患者72例作为对照(对照组)。入选患者均行二尖瓣峡部线性消融手术,术中验证二尖瓣峡部线阻断情况,术后随访房性心律失常和心包积液发生情况,均随访12个月以上。结果:VOM组术中验证二尖瓣峡部线阻断63例,其中需要联合心内和心外膜补点消融达到二尖瓣峡部线14例,未能阻断二尖瓣峡部线9例。对照组术中验证二尖瓣峡部线53例,未能阻断19例。随访12~20个月,VOM组房性心律失常复发20例,而对照组房性心律失常复发30例。结论:在持续性房扑、房颤消融治疗中,经VOM行无水乙醇注射能有效阻断二尖瓣峡部线性传导,有助于提高二尖瓣峡部线成功率,减少房颤消融术中二尖瓣峡部相关的房扑发生率,且不增加严重并发症的发生率。Objective:To evaluate the efficiency and safety of the vein of Marshall(VOM)ethanol infusion for mitral isthmus ablation in persistent atrial flutter and atrial fibrillation.Methods:From September 2019 to May 2020,collecting clinical data of 72 patients with atrial fibrillation or flutter(VOM group),who had been undergoing ethanol injections into VOM and radiofrequency ablation,including clinical characteristics,mitral isthmus block.72 patients with atrial fibrillation or flutter undergoing radiofrequency ablation were enrolled as control group.All patients underwent mitral isthmus linear ablation.The occlusion of mitral isthmus was verified during operation,and atrial arrhythmia and pericardial effusion were followed up for more than 12 months.Results:In group of VOM ethanol infusion,achieved bidirectional mitral isthmus block in 63 patients,needed to combine with radiofrequency ablation to achieve bidirectional mitral isthmus block in 14 patients,failed to achieve bidirectional mitral isthmus block in 9 patients.In control group,achieved bidirectional mitral isthmus block in 53 patients,failed to achieve bidirectional mitral isthmus block in 19 patients.Follow-up for 12 to 20 months,there were 20 patients of recurrent atrial arrhythmia in VOM group and 30 patients of recurrent atrial arrhythmia in control group.Conclusion:VOM ethanol infusion is useful in the treatment of atrial fibrillation or atrial flutter and assists in reliably achieving bidirectional mitral isthmus block.It does not increase the incidence of serious complications.

关 键 词：心房颤动 心房扑动 Marshall静脉 无水乙醇 射频消融术 

分 类 号：R541.75[医药卫生—心血管疾病]