CAJ | 학술논문

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1例,中位年龄46岁(33～64岁),左心室流出道压力阶差70～100 mm Hg(1 mm Hg =0.133 kPa),消融间隔支1～2支,无水酒精用量中位数为1.8 ml(1.4 ～4.3 ml),其中4例术中曾出现三度房室传导阻滞,晚发时间为术后32 h(28 ～120 h),R-R最长间歇为30 s.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,再次置入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人时间,术后严密监测心律变化,适当延长住院时间.
목적 분석비후형심기병화학소융술후합병만발삼도방실전도조체5례환자적림상특점.방법 회고성분석2000년12월지2011년12월북경부외심혈관병의원비후형심기병화학소융술환자235례중합병만발삼도방실전도조체적5례환자적림상자료.결과 235례환자중합병만발삼도방실전도조체자5례,발생솔위2.1％.5례환자중남성4례,녀성1례,중위년령46세(33～64세),좌심실류출도압력계차70～100 mm Hg(1 mm Hg =0.133 kPa),소융간격지1～2지,무수주정용량중위수위1.8 ml(1.4 ～4.3 ml),기중4례술중증출현삼도방실전도조체,만발시간위술후32 h(28 ～120 h),R-R최장간헐위30 s.5례환자중3례발생훈궐,기중2례발생아사종합정.5례환자균급시발현,재차치입림시기박기후심률회복정상.결론 비후형심기병화학소융술후만발삼도방실전도조체발생솔저,단엄중위협환자생명안전,응연장림시기박기치인시간,술후엄밀감측심률변화,괄당연장주원시간.
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 1 female.Left ventricular outflow gradient before ablation was 70-100 mm Hg(1 mm Hg =0.133 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.