自制穿孔球囊行Marshall静脉无水乙醇消融联合个体化消融策略治疗持续性心房颤动1例  

A case of persistent atrial fibrillation treated with Marshall intravenous ethanol ablation with self-made perforated balloon combined with individualized ablation strategy

作　　者：唐名扬 刘波[1] 蔡炜 黄晓华 黄禄勇[1] 欧登科 TANG Ming-yang;LIU Bo;CAI Wei;HUANG Xiao-Hua;HUANG Lu-yong;OU Deng-ke(Department of Cardiovascular Medicine,Chengdu Fifth People’s Hospital Affiliated to Chengdu University of Traditional Chinese Medicine,Chengdu 611130,China)

机构地区：[1]成都市第五人民医院心血管内科,四川成都611130

出　　处：《中国介入心脏病学杂志》2024年第6期353-356,共4页Chinese Journal of Interventional Cardiology

基　　金：成都市高水平临床重点专科建设项目(2021GSPZX-04);四川省医学科研青年创新课题项目(Q23101)。

摘　　要：在射频消融术治疗持续性心房颤动(房颤)时常需要在环肺静脉电隔离的基础上增加肺静脉外触发灶的消融,包括线性消融、BOX消融及碎裂电位消融等。二尖瓣峡部是线性消融最重要的组成部分,但传统射频消融很难将二尖瓣峡部进行彻底阻滞。经下腔静脉送入指引导管至冠状静脉窦,Marshall静脉注入无水乙醇消融可实现二尖瓣峡部心外膜和心肌阻滞,再联合二尖瓣峡部心内膜补点消融能显著提升消融效果,但存在Marshall静脉、冠状静脉损伤、手术费用高昂、耗时长等弊端。本文报道1例经自制穿孔球囊行Marshall静脉无水乙醇联合个体化消融策略治疗的持续性房颤患者,出院后随访6个月,无主要不良心血管事件的发生及房颤的复发。In the treatment of persistent atrial fibrillation with radiofrequency ablation,it is often necessary to add the ablation of external trigger foci of pulmonary vein on the basis of annular pulmonary vein isolation,including linear ablation,BOX ablation and fragmentation potential ablation.The isthmus of mitral valve is the most important component of linear ablation,but it is difficult to reach the isthmus of mitral valve for complete blockade by conventional radiofrequency ablation.The guide catheter was transported through the inferior vena cava to the coronary sinus,and the injection of Marshall vein anhydrous ethanol for ablation could achieve epicardial and myocardial block in the mitral isthmus,and the ablation combined with the endocardial patch ablation in the mitral isthmus could significantly improve the ablation effect,but there were disadvantages such as Marshall vein and coronary vein injury,high surgical cost and long time.This paper reports a case of persistent atrial fibrillation treated by self-made perforated balloon with Marshall intravenous anhydrous ethanol combined with individualized ablation strategy.No major adverse cardiovascular events or recurrence of atrial fibrillation occurred during 6 months of follow-up after discharge.

关 键 词：持续性心房颤动 射频导管消融术 Marshall静脉 自制穿孔球囊 

分 类 号：R541.75[医药卫生—心血管疾病]