CAJ | 학술논문

目的探讨肥厚型梗阻性心肌病(HOCM)行经皮经腔间隔心肌化学消融术(PTSMA)中急性房室传导阻滞对预后的影响.方法入选94例HOCM患者行PTSMA,术中及术后严密监测心电图变化,分析术中出现的各种心律失常对患者预后的影响.结果术中出现急性完全件房室传导阻滞的26例患者中,返回冠心病监护病房后有11例(42.3%)出现亚急性室内传导阻滞,2例(7.7%)出现亚急性一度房室传导阻滞,2例(7.7%)出现亚急性完伞性房窒传导阻滞,其余11例均为术中出现的一过性传导阻滞,术后均恢复正常传导.术中未出现急性完全性房室传导阻滞的68例患者中,术后14例(20.6%)出现亚急性室内传导阻滞,2例(2.9%)出现亚急性一度房室传导阻滞,1例(1.5%)出现亚急性完全性房室传导阻滞.在术中出现急性传导阻滞并继发亚急性传导阻滞的患者预后不良,传导阻滞持续时间平均42.00 h,术中无急性传导阻滞而术后新发亚急性传导阻滞的患者,传导阻滞持续时间平均7.33 h(P<0.01).结论 PTSMA 中出现急性传导阻滞的患者,术后容易继发亚急性传导阻滞,特别是室内传导阻滞,并且传导系统恢复时间较长;而术中未出现传导阻滞的患者,即使术后出现亚急性传导阻滞,传导系统恢复也较快.
목적 탐토비후형경조성심기병(HOCM)행경피경강간격심기화학소융술(PTSMA)중급성방실전도조체대예후적영향.방법 입선94례HOCM환자행PTSMA,술중급술후엄밀감측심전도변화,분석술중출현적각충심률실상대환자예후적영향.결과 술중출현급성완전건방실전도조체적26례환자중,반회관심병감호병방후유11례(42.3%)출현아급성실내전도조체,2례(7.7%)출현아급성일도방실전도조체,2례(7.7%)출현아급성완산성방질전도조체,기여11례균위술중출현적일과성전도조체,술후균회복정상전도.술중미출현급성완전성방실전도조체적68례환자중,술후14례(20.6%)출현아급성실내전도조체,2례(2.9%)출현아급성일도방실전도조체,1례(1.5%)출현아급성완전성방실전도조체.재술중출현급성전도조체병계발아급성전도조체적환자예후불량,전도조체지속시간평균42.00 h,술중무급성전도조체이술후신발아급성전도조체적환자,전도조체지속시간평균7.33 h(P<0.01).결론 PTSMA 중출현급성전도조체적환자,술후용역계발아급성전도조체,특별시실내전도조체,병차전도계통회복시간교장;이술중미출현전도조체적환자,즉사술후출현아급성전도조체,전도계통회복야교쾌.
Objective To investigate the prognostic value of acute beart block (AHB) after percutaneous transluminal septal myocardial ablation (PTSMA) in patients with hypertrophic obstructive cardiomyopathy (HOCM). Methods Ninety-four HOCM patients underwent PTSMA were included in this study. Twelve-lead electrocardiograms were obtained during and post PTSMA. Association between clinic events and incidence of post-PTSMA AHB was analyzed. Results AHB was induced in 26 patients by PTSMA and disappeared in 11 patients shortly post PTSMA, subacute intraventricular conduction disturbances was seen in 11 (42.3%), subacute I°AVB in 2(7.7% ) and subacute Ⅲ°AVB in another 2 (7.7%) patients. Among 68 patients without AHB during PTSMA, intraventricular conduction disturbances was evidenced in 14 patients (20.6% ), I°AVB in 2 (2.9% ) and Ⅲ°AVB in 1 patient (1.5%) after PTSMA. AHB patients with subacute heart block were associated with poor prognosis (conduction block duration was 42.00 h) while patients without AHB was associated with benign prognosis even with new onset of subacute heart block (conduction block duration was 7.33 h, P <0.01). Conclusion Patients with AHB during PTSMA are at higher risk for subacute heart block, especially intraventricolar conduction disturbances. AHB patients with subacute heart block were associated with poor prognosis and longer recovery time conducting system.