经皮心肌内室间隔射频消融术治疗梗阻性肥厚型心肌病术后心电的变化  

Percutaneous intramyocardial septal radiofrequency ablation for the treatment of obstructive hypertrophic cardiomyopathy:postoperative electrocardiogram changes

作　　者：刘莎 马志玲 邵虹 耶闯 高超 付国涛 LIU Sha;MA Zhi-ling;SHAO Hong;YE Chuang;GAO Chao;FU Guotao(Department of Cardiology,Xijing Hospital,Air Force Military Medical University,Xi'an 710032,Shaanxi,China)

机构地区：[1]空军军医大学第一附属医院心血管内科,陕西西安710032

出　　处：《中国心脏起搏与心电生理杂志》2024年第2期100-104,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的 通过动态心电图和超声心动图(UCG)观察梗阻性肥厚型心肌病(HOCM)患者接受经皮心肌内室间隔射频消融术(PIMSRA)治疗术后1周、术后6个月心电变化以及结构改变是否对心电活动造成影响。方法 纳入2020年6月至2023年2月诊断为HOCM接受PIMSRA治疗的患者。收集其临床资料,既往史、危险因素、纽约心功能分级等;在术前、术后1周、术后6个月,分别采用24 h动态心电图评价心率、室性心律失常、室上性心律失常、ST段改变情况以及传导阻滞变化情况;采用经UCG测量室间隔厚度、左室流出道压差、左室射血分数、收缩期二尖瓣前叶前向运动(SAM征)。对上述指标在术前、术后1周、术后6个月的变化情况进行评估。结果 连续纳入99例患者,年龄(44.7±13.8)岁,67.7%为男性,41.4%患有心力衰竭。在接受PIMSRA后,与术前比较,在术后1周中最快心率比例显著减小,室性早搏(简称室早)总数、短阵室性心动过速(简称室速)、最大ST段抬高值比例显著升高;术后6个月,最快心率,室早总数、短阵室速、最大ST段抬高值相比术前无统计学差异;8例(8.1%)术后1周出现一过性传导阻滞和干扰性脱节(完全性右束支传导阻滞4例、干扰性脱节及加速性交界性心律4例、室内传导阻滞1例),而术前、术后6个月均正常;1例(1.0%)出现永久性完全性右束支传导阻滞。与术前比较,在术后1周,6个月室间隔厚度,流出道压差均显著性减小(P<0.05),NYHA I级比率,SAM征阴性比率均呈现显著性增加(P<0.05),余指标未发现显著增加或减小。结论 PIMSRA术后1周室早总数增多,室性心律失常事件增高,消融部位ST段抬高值增加,8.1%患者术后1周出现各种一过性传导阻滞和干扰性脱节及交界性心律。1.0%患者术后出现永久完全性右束支传导阻滞。Objective To observe the ECG changes in patients with obstructive hypertrophic cardiomyopathy(HOCM)1 week after percutaneous intramyocardial septal radiofrequency ablation(PIMSRA)and 6 months after PIMSRA through dynamic electrocardiography and echocardiography(UCG).Methods Patients diagnosed with HOCM and treated with PIMSRA from June 2020 to February 2023 were included.Their clinical data,past history,risk factors,New York heart function,etc.were collected;before surgery,1 week after PIMSRA,and 6 months after PIMSRA,24-hour dynamic electrocardiography was used to evaluate heart rate,ventricular arrhythmias,and supraventricular arrhythmias,ST segment changes and conduction block changes;UCG was used to measure interventricular septal thickness,left ventricular outflow tract pressure difference,left ventricular ejection fraction,and systolic anterior mitral valve anterior leaflet motion(SAM sign).The changes in the above indicators before PIMSRA,1 week after PIMSRA,and 6 months after PIMSRA were evaluated.Results Ninety-nine patients were consecutively included,aged(44.7±13.8)years old,67.7%were male,and 41.4%had heart failure.After receiving PIMSRA,compared with before surgery,the proportion of the fastest heart rate was significantly reduced in the first week after surgery,the total number of premature ventricular contractions(PvC),short burst ventricular tachycardia,the proportion of maximum ST segment elevation values increased significantly;6 months after surgery,there were no statistical differences in the fastest heart rate,total number of PVC,short bursts of ventricular tachycardia,and maximum ST segment elevation values compared with those before surgery;8 cases(8.1%)transient conduction block and interfering disjoint occurred 1 week after surgery(4 cases of complete right bundle branch block,4 cases of interfering disjoint and accelerated junctional rhythm,and 1 case of intraventricular conduction block),and the results were normal before surgery and 6 months after surgery;1 case(1.0%)developed permane

关 键 词：心血管病学 梗阻性肥厚型心肌病 经皮心肌内室间隔射频消融术 动态心电图 超声心动图 

分 类 号：R542.2[医药卫生—心血管疾病] R454.1[医药卫生—内科学] R540.41[医药卫生—临床医学]