摘要
目的分析肥厚型心肌病化学消融术后合并晚发三度房室传导阻滞5例患者的临床特点。方法回顾性分析2000年12月至2011年12月北京阜外心血管病医院肥厚型心肌病化学消融术患者235例中合并晚发三度房室传导阻滞的5例患者的临床资料。结果235例患者中合并晚发三度房室传导阻滞者5例，发生率为2．1％。5例患者中男性4例，女性l例，中位年龄46岁（33～64岁），左心室流出道压力阶差70～100mmHg（1mmHg=0．133kPa），消融间隔支1～2支，无水酒精用量中位数为1．8ml（1．4～4．3m1），其中4例术中曾出现三度房室传导阻滞，晚发时间为术后32h（28～120h），R—R最长间歇为30s。5例患者中3例发生晕厥，其中2例发生阿斯综合征。5例患者均及时发现，再次置人临时起搏器后心律恢复正常。结论肥厚型心肌病化学消融术后晚发三度房室传导阻滞发生率低，但严重威胁患者生命安全，应延长临时起搏器置入时间，术后严密监测心律变化，适当延长住院时间。
Objective To analyze the clinical features of patients with delayed third degree atrioventricular block after ethanol septal ablation for hypertrophic obstructive cardiomyopathy. Method The clinical data of cases with delayed third degree atrioventricular block after septal ablation for hypertrophic obstructive cardiomyopathy at our hospital from 2000 to 2011 were collected. Result Five out of 235 patients （2. 1% ） developed delayed third degree atrioventricular block. Delayed third atrioventricular block occurred at 32 h post ablation （28 - 120 h）. Their average age is 46 （33 -64）years old, there are 4 males and l female. Left ventricular outflow gradient before ablation was 70 - 100 mm Hg（ 1 mm Hg = O. 133 kPa）. Intraprocedural third degree atrioventricular block occurred in 4 patients. The average injected dose of Ethanol was 1.8 （ 1.4 - 4. 3 ） ml. Syncope occurred in 3 patients. Temporary pacemaker was reimplanted to all 5 patients and removed after an average of 8 d （3 - 18 d）. All 5 patients were in normal sinus rhythmus at discharge without the need of implanting permanent pacemaker. There was no syncope in these 5 patients after discharge during the telephone follow up for an average of 9 （ 1 - 72 ） months. Conclusion The incidence of delayed third degree atrioventricular block after septal ablation is rare. Prolonged electrocardiography monitoring and prophylactic temporary pacemaker backup post ablation are necessary to detect this event and to prevent syncope related to delayed third degree atrioventricular block after septal ablation.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2012年第12期1009-1011,共3页
Chinese Journal of Cardiology
