血流动力学不稳定的室性心动过速循环辅助支持下的导管消融治疗

Early experience with mechanical hemodynamic support for catheter ablation of malignant ventricular tachycardia

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中文摘要：目的探讨循环辅助支持在血流动力学不稳定的室性心动过速患者的标测及导管消融治疗中的作用,对该类患者的单中心经验进行总结分析,为临床提供循证医学证据.方法该研究为回顾性队列研究.纳入2021年8月至2023年12月于首都医科大学附属北京安贞医院在循环辅助支持下接受导管消融手术的血流动力学不稳定的室性心动过速患者,根据治疗目的分为挽救性治疗组和预防性治疗组,对两组患者的人口学资料、围术期管理、导管消融情况及临床结局进行总结.结果共纳入15例血流动力学不稳定的室性心动过速患者(挽救性治疗组8例,预防性治疗组7例),所有患者手术均获得即刻成功.1例患者(挽救性治疗组)植入左心室辅助装置,其余14例患者均采用体外膜肺氧合进行循环支持.术后在院期间,12例患者临床和血流动力学稳定,进行了体外膜肺氧合撤机,其中6例术后即刻撤机,其余在术后2.0(2.5)d撤机.挽救性治疗组中2例患者在院期间分别因顽固性心力衰竭和脑出血死亡.在30d(l d至12个月)的随访中,植入左心室辅助装置的1例患者在出院后第6个月出现1次心室颤动,经抗心律失常药物治疗后未再出现心室颤动和(或)室性心动过速.其余12例患者术后均未发生恶性室性心律失常事件.结论循环辅助支持有助于血流动力学不稳定的室性心动过速患者完成激动标测及精准消融;尤其是急诊条件下,循环辅助支持是药物治疗无效的血流动力学不稳定的室性心动过速患者得以行急诊导管消融的唯一支持手段.

外文摘要：J Objective To explore the role of mechanical hemodynamic support(MHS)in mapping and catheter ablation of patients with hemodynamically unstable ventricular tachycardia(VT),report single-center experience in a cohort of consecutive patients receiving VT ablation during MHS therapy,and provide evidence-based medical evidence for clinical practice.Methods This was a retrospective cohort study.Patients with hemodynamically unstable VT who underwent catheter ablation with MHS at Beijing Anzhen Hospital,Capital Medical University between August 2021 and December 2023 were included.Patients were divided into rescue group and preventive group according to the purpose of treatment.Their demographic data,periprocedural details,and clinical outcomes were collected and analyzed.Results A total of 15 patients with hemodynamically unstable VT were included(8 patients in the rescue group and 7 patients in the preventive group).The acute procedure was successful in all patients.One patient in the rescue group had surgical left ventricular assist device(LVAD)implantation,remaining 14 patients received extracorporeal membrane oxygenation(ECMO)for circulation support.ECMO decannulation was performed in 12 patients due to clinical and hemodynamic stability,of which 6 patients were decannulation immediately after surgery and the remaining patients were decannulation at 2.0(2.5)d after surgery.Two patients in the rescue group died during the index admission due to refractory heart failure and cerebral hemorrhage.During a median follow-up of 30 d(1 d to 12 months),one patient with LVAD had one episode of ventricular fibrillation at 6 months after discharge,and no further episodes of ventricular fibrillation and/or VT occurred after treatment with antiarrhythmic drugs.No malignant ventricular arrhythmia occurred in the remaining 12 patients who were followed up.Conclusions MHS contributes to the successful completion of mapping and catheter ablation in patients with hemodynamically unstable VT,providing desirable hemodynamic status for emergency and elective conditions.

外文关键词：

Catheter ablationVentricular tachycardiaMechanical circulatory supportHemodynamical instabilityExtracorporeal membrane oxygenationLeft ventricular assist device

作者：

李梦梦、杨扬、龙德勇、蒋晨曦、汤日波、桑才华、王伟、赵欣、郭雪原、李松南、李昌义、宁曼、贾长琪、冯莉、温丹、朱慧、江岳鑫、刘放、刘佟、董建增、马长生

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作者单位：

首都医科大学附属北京安贞医院心律失常中心国家心血管疾病临床医学研究中心,北京 100029

关键词：

导管消融术室性心动过速循环辅助治疗血流动力学不稳定体外膜肺氧合左心室辅助装置

基金：

国家自然科学基金国家自然科学基金

项目编号：

8215130682070339

出版年：

2024

DOI：

10.3760/cma.j.cn112148-20240410-00194

中华心血管病杂志

中华医学会

中华心血管病杂志

CSTPCD北大核心

影响因子：2.846

ISSN：0253-3758

年,卷(期)：2024.52(7)