心律失常诱导的心肌病导管射频消融结果与随访

程宽; 陈庆兴; 庞晹; 徐烨; 凌云龙; 刘桂剑; 朱文青

doi:10.13201/j.issn.1001-1439.2021.03.009

心律失常诱导的心肌病导管射频消融结果与随访

- 复旦大学附属中山医院心内科上海市心血管病研究所(上海, 200032)
基金项目:
上海市科学技术委员会科研计划项目(No:17DZ1930102、17DZ1930303)

详细信息

通讯作者: 朱文青,E-mail:zhu.wenqing@zs-hospital.sh.cn

中图分类号: R541.7

收稿日期: 2020-08-30

修回日期: 2021-01-02

Results and long-term follow-up of radiofrequency catheter ablation for arrhythmia-induced cardiomyopathy

- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China

More Information

Corresponding author: ZHU Wenqing, E-mail: zhu.wenqing@zs-hospital.sh.cn

Received Date: 30 August 2020

Revised Date: 02 January 2021

摘要

摘要: 目的:探讨心律失常诱导的心肌病(AIC)导管射频消融(RFCA)治疗效果与长期预后。方法:选择2013年1月—2017年12月收治的AIC患者14例,进行临床评估和RFCA手术,并长期随访观察病情演变和预后。结果:14例AIC患者中,心动过速7例(50.0%),包括房室折返性心动过速(AVRT)2例(14.3%),左心耳起源房性心动过速(AT)2例(14.3%),心房颤动(房颤)3例(21.4%),频发室性期前收缩(室早)7例(50.0%)。1例左心室顶部心外膜起源室早消融失败,其余病例均成功。RFCA术前,心动过速患者的纽约心功能分级(NYHA)差于室早患者(1.4±0.2∶2.9±0.4,P<0.05),心室率快于室早患者[(72.1±3.1)次/min∶(139.0±13.5)次/min,P<0.01]。RFCA术后3个月时,心动过速患者心室率较术前降低[(139.0±13.5)次/min∶(79.7±9.8)次/min,P<0.01]。与术前相比,14例患者术后3个月时心率[(105.6±36.0次/min∶(76.1±7.8)次/min,P<0.01]、左心室舒张末期内径(LVEDd)[(58.5±8.7) mm∶(53.4±6.3) mm,P<0.01]、左心室射血分数(LVEF)[(43.4±6.6)%∶(57.1±4.9)%,P<0.01]、NYHA分级(2.1±0.9∶1.1±0.4,P<0.01)均恢复正常或接近正常。随访(54.1±18.7)个月,初始RFCA成功者均无心律失常复发,14例患者的NYHA分级、LVEDd、LVEF等指标保持稳定,共8例(57.1%)患者停用药物,无心功能恶化、猝死发生。结论:AIC患者通过RFCA以及药物治疗去除或控制心律失常后,左心室功能可完全或明显恢复,长期预后良好,部分患者可避免长期药物治疗。
- 心律失常诱导的心肌病 /
- 心动过速心肌病 /
- 导管射频消融 /
- 室性期前收缩 /
- 心动过速
Abstract: Objective: To investigate the effects and long-term prognosis of radiofrequency catheter ablation(RFCA) in patients with arrhythmia-induced cardiomyopathy(AIC).Methods: Eleven patients with AIC admitted from January 2013 to December 2017 were selected for clinical evaluation and RFCA. Long term follow-up was conducted to observe the disease evolution and prognosis.Results: Among the 14 patients with AIC, tachycardia occurred in 7 cases(50.0%), including 2 cases(14.3%) with atrioventricular reentrant tachycardia(AVRT), 2 cases(14.3%) with atrial tachycardia(AT) origin from left atrial appendage, 3 cases(21.4%) with atrial fibrillation(AF); and frequent premature ventricular contractions(PVCs) occurred in 7 cases(50.0%). One case with PVCs origin from left ventricular summit failed in ablation, and the other cases were successful. Before RFCA, NYHA grade was worse( 1.4 ±0.2 vs 2.9 ±0.4, P<0.05), and the ventricular rate was faster([72.1±3.1]beats/min vs [139.0±13.5]beats/min, P<0.01) in patients with tachycardia than those in patients with PVCs. Three months after RFCA, the ventricular rate in patients with tachycardia was lower than that before ablation. Three months after operation, the heart rate([105.6 ±36.0]beats/min vs [76.1 ±7.8]beats/min, P<0.01), left ventricular end diastolic diameter(LVEDd)([58.5 ±8.7]mm vs [53.4 ±6.3]mm, P<0.01), left ventricular ejection fraction(LVEF)([43.4 ±6.3]% vs [57.1±4.9]%, P<0.01), and NYHA grade(2.1 ±0.9 vs 1.1 ±0.4, P<0.01) returned to normal or nearly normal in all 14 patients. Followed up for(54.1 ±18.7) months, no arrhythmia recurred in patients with successful initial RFCA. The NYHA grade, LVEDd, and LVEF in all 14 patients remained stable. Eight patients(57.1%) discontinued the drug therapy, and no cardiac function deterioration or sudden death occurred.Conclusion: After removing or controlling arrhythmia by RFCA and drug therapy, the left ventricular function in patients with AIC can be completely or significantly recovered, the long-term prognosis is optimistic, some patients can avoid long-term drug therapy.
- arrhythmia-induced cardiomyopathy /
- tachycardiomyopathy /
- radiofrequency catheter ablation /
- premature ventricular contractions /
- tachycardia

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参考文献(18)

[1]	Lishmanov A,Chockalingam P,Senthilkumar A,et al.Tachycardia-induced cardiomyopathy:evaluation and therapeutic options[J].Congest Heart Fail,2010,16(3):122-126.
[2]	Simantirakis EN,Koutalas EP,Vardas PE.Arrhythmia-induced cardiomyopathies:the riddle of the chicken and the egg still unanswered?[J].Europace,2012,14(4):466-473.
[3]	程中伟,朱运锋.心动过速性心肌病[J].心电图杂志(电子版),2015,4(2):71-73.
[4]	Gopinathannair R,Etheridge SP,Marchlinski FE,et al.Arrhythmia-Induced Cardiomyopathies:Mechanisms,Recognition,and Management[J].J Am Coll Cardiol,2015,66(15):1714-1728.
[5]	韩晓华,王凤,吴琳.儿童心动过速性心肌病[J].中华实用儿科临床杂志,2017,32(1):72-74.
[6]	Martin CA,Lambiase PD.Pathophysiology,diagnosis and treatment of tachycardiomyopathy[J].Heart,2017,103(19):1543-1552.
[7]	郭继鸿.室早性心肌病发生机制的探讨[J].临床心电学杂志,2015,24(3):215-226.
[8]	匡雪,胡文,刘增长.室性期前收缩性心肌病研究进展[J].心血管病学进展,2018,39(3):343-346.
[9]	王皎.室性期前收缩性心肌病诊疗进展[J].心血管病学进展,2020,41(6):563-566.
[10]	中华医学会超声医学分会超声心动图学组.中国成年人超声心动图检查测量指南[J].中华超声影像学杂志,2016,25(8):645-666.
[11]	曾晨卉,范咏梅,邓策,等.不同心电学特征的单发室性期前收缩对心脏瞬时泵血功能的影响[J].临床心血管病杂志,2020,36(2):183-188.
[12]	中华医学会心电生理和起搏分会,中国医师协会心律学专业委员会.2020室性心律失常中国专家共识(2016共识升级版)[J].中国心脏起搏与心电生理杂志,2020,34(3):189-253.
[13]	赵彦蕾,张艳,吴敬兰,等.不同起源部位频发室性期前收缩射频消融术对左心房结构及功能的影响[J].临床心血管病杂志,2019,35(8):746-751.
[14]	Nerheim P,Birger-Botkin S,Piracha L,et al.Heart failure and sudden death in patients with tachycardia-induced cardiomyopathy and recurrent tachycardia[J].Circulation,2004,110(3):247-52.
[15]	Ju W,Yang B,Li M,et al.Tachycardiomyopathy complicated by focal atrial tachycardia:incidence,risk factors,and long-term outcome[J].J Cardiovasc Electrophysiol,2014,25(9):953-957.
[16]	黄从新,张澍,黄德嘉,等.心房颤动:目前的认识和治疗建议(2018)[J].中华心律失常学杂志,2018,22(4):279-346.
[17]	中华医学会心血管病学分会,中国医师协会心血管内科医师分会,中华心血管病杂志编辑委员会.心肌病磁共振成像临床应用中国专家共识[J].中华心血管病杂志,2015,43(8):673-681.
[18]	刘晓庆,肖秋月,邵国柱,等.磁共振定量技术评价心肌炎患者双室心肌应变功能的初步临床研究[J].临床心血管病杂志,2019,35(6):534-539.