室性期前收缩射频消融术中心脏压塞的发生率、原因及处理分析
Incidence,Cause and Treatment of Cardiac Tamponade in Radiofrequency Ablation of Ventricular Premature Contractions
殷建龙 1李腾 1李华龙 1彭文杰 1李超 1梁建 1廖志勇 1李宜富1
作者信息
- 1. 中国医学科学院阜外医院深圳医院心律失常科,广东深圳 518057
- 折叠
摘要
目的 探讨室性期前收缩射频消融术中心脏压塞的发生率、原因及处理分析.方法 回顾性分析中国医学科学院阜外医院深圳医院2016年1月至2022年6月1 460例患者行室性期前收缩射频消融术的临床资料,14例(0.96%)发生心脏压塞.结果 14例患者年龄为(62±12)岁,其中男性3例(0.40%),女性13例(1.23%).标测、消融及导管情况:术中机械损伤所致心脏压塞10例(71.4%),消融损伤所致心脏压塞4例(28.6%);强生TC 6例,ST 2例,Navistar 4 mm 1例;雅培Coolflex导管2例;波科Nav Mifi导管1例;雅培Array球囊电极及Safire双弯导管2例.93%(13/14)患者穿孔发生在右心室流出道(right ventricular outflow tract,RVOT).12例心包穿刺引流好转,1例需要紧急外科开胸修补,1例保守治疗未行心包穿刺引流.所有心脏压塞患者发现、抢救及时,均无死亡.结论 室性期前收缩射频消融术的心脏压塞发生率不低,多发生于RVOT,需要及时识别、及早处理,绝大部分患者经心包穿刺引流治疗后好转,少部分需紧急外科开胸修补.
Abstract
Objectives To investigate the incidence,causes and management of cardiac tamponade during radiofre-quency ablation of premature ventricular contractions(PVC).Methods A retrospective analysis was performed on 1 460 patients who underwent radiofrequency ablation of PVC in Fuwai Hospital Chinese Academy of Medical Science Shenzhen from January 2016 to June 2022.Fourteen patients(0.96%)developed cardiac tamponade.Results The average age of the 14 patients was(62±12)years,including 3 males(0.40%)and 13 females(1.23%).Mapping,ablation and catheter:10 cases(71.4%)of cardiac tamponade caused by mechanical injury,4 cases(28.6%)of cardiac tamponade caused by ablation injury.There were TC in 6 cases,ST in 2 cases,Navistar 4 mm in 1 case.The Coolflex catheter was used in 2 cases.Nav Mifi catheter(Boston Scientific Corporation)in 1 case.Array balloon electrode(Abbott)and Safire double-curved catheter(Abbott)were used in 2 cases.Right ventricular outflow tract(RVOT)perforation occurred in 93%(13/14)of patients.Pericardiocentesis and drainage were improved in 12 cases,emergency surgical repair was required in 1 case,and 1 case was treated conservatively without pericardiocentesis and drainage.All the patients with cardiac tamponade were found and rescued in time,and there was no death.Conclusions The incidence of cardiac tamponade in radiofrequency ablation of PVC is not low,and most of them occur in RVOT,which needs timely identifi-cation and early treatment.Most patients improve after pericardiocentesis and drainage,and a small number of patients need emergency surgical repair.
关键词
室性期前收缩/射频消融/心脏压塞/心包穿刺Key words
ventricular premature contraction/radiofrequency ablation/cardiac tamponade/pericardiocentesis引用本文复制引用
基金项目
深圳市科技计划项目(JCYJ20180302173927276)
出版年
2024
NETL
NSTL
万方数据