摘要
目的:分析心房颤动(房颤)射频导管消融术治疗过程中心电图ST段抬高的发生率、临床特征及预后。方法:回顾性分析2021年1月至2023年8月铜仁市人民医院、毕节市七星关区人民医院、贵州省人民医院行射频导管消融术治疗的798例房颤患者,所有患者均在局部麻醉下经房间隔途径行CARTO三维电解剖标测及射频消融,记录术中心电图ST段抬高情况。对心电图ST段抬高患者于术后第1、3、6、12个月进行随访,随访指标包括房颤复发及复发时间、抗心律失常药物应用以及是否发生死亡、血栓栓塞、出血及围术期并发症。结果:5例患者在射频导管消融术治疗过程中出现心电图ST段抬高,发生率为0.62%。3例患者ST段抬高发生在房间隔穿刺过程中,2例发生在PentaRay标测电极建立左心房电解剖模型过程中。3例患者为短暂性ST段抬高(抬高时间<20 min),症状发作时血压升高;2例患者呈持续性ST段抬高(抬高时间>20 min),发生严重低血压,给予血管活性药物处理。4例患者经观察及药物处理后完成射频导管消融术,1例患者因严重血液动力学障碍终止手术,于术后5 d死亡,余4例患者无围术期并发症。术后平均随访(6±3)个月,仅1例患者术后6个月出现短阵房性心动过速,余病例未见房颤复发及心悸症状。结论:射频导管消融术治疗房颤过程中可能会发生短暂性或持续性心电图ST段抬高,及早发现及快速处理能够预防恶性事件,具有良好的预后。
Objectives:This study aimed to elucidate the incidence,clinical characteristics and prognosis of ST-elevation during radiofrequency catheter ablation for atrial fibrillation(AF).Methods:Consecutive patients who underwent radiofrequency catheter ablation for AF in Tongren Municipal People's Hospital,Qixingguan District People's Hospital of Bijie City and Guizhou Provincial People's Hospital from January 2021to August 2023 were enrolled in this study.All patients underwent CARTO three-dimensional electroanatomical mapping and radiofrequency ablation via atrial septal approach under local anesthesia.The ST-elevation of electrocardiogram was analyzed.Follow-up was performed at 1,3,6,and 12 months after radiofrequency ablation.AF recurrence and duration,use of antiarrhythmic drugs,and incidence of death,thromboembolism,bleeding,and perioperative complications were evaluated.Results:ST-elevation was observed in 5 out of 798 patients(0.62%).ST-elevation occurred after transseptal puncture in three patients and during PentaRay multielectrode mapping in two patients.Blood pressure was significantly increased in three patients with transient ST-elevation(<20 min) and hemodynamic collapse occurred in two patients with persistent STelevation(>20 min).Catheter ablation of AF was completed in 4 patients,1 patient suffered severe hemodynamic disorders during radiofrequency catheter ablation,and the procedure was stopped immediately,this patient died from multiple organ system failure on the fifth day after failed radiofrequency catheter ablation,and the other 4 patients had no perioperative complications.The mean follow-up was(6±3) months,only 1 patient developed short atrial tachycardia,and the other patients had no recurrent atrial fibrillation and palpitation.Conclusions:Transient or persistent ST elevation can occur in patients during AF ablation.Early detection and rapid management are needed to prevent severe hemodynamic instability and cardiogenic death.
作者
龚福汉
刘振良
刘启方
田龙海
田野
杨英
杨龙
GONG Fuhan;LIU Zhenliang;LIU Qifang;TIAN Longhai;TIAN Ye;YANG Ying;YANG Long(Department of Cardiology,Tongren Municipal People's Hospital,Tongren 554300,China;Department of Cardiology,Qixingguan District People's Hospital of Bijie City,Bijie 551700,China;Department of Cardiology,Guizhou Provincial People's Hospital,Guiyang 550002,China)
出处
《中国循环杂志》
CSCD
北大核心
2024年第9期865-870,共6页
Chinese Circulation Journal
基金
贵州省科学技术厅临床研究中心项目[黔科合平台(2017)5405号]
贵州省科学技术厅项目[黔科合基础(2022)一般255号]
贵州省卫生健康委科学技术基金(gzwkj 2021-110)。
关键词
心房颤动
导管消融
ST段抬高
冠状动脉痉挛
atrial fibrillation
catheter ablation
ST-elevation
coronary artery spasm
