介入治疗继发孔房间隔缺损合并心律失常的临床研究

Clinical study in patients with foramen secundum atrial septal defect combined with arrhythmia by interventional therapy

目的介绍介入治疗继发孔房间隔缺损（ASD）合并严重心律失常的临床体会。方法54例心律失常患者中，心房纤颤20例，频发室性早搏10例，频发房性早搏4例，室上性心动过速3例，室性心动过速1例，Ⅰ°房室传导阻滞（AVB）14例，Ⅱ°、Ⅲ°AVB各1例。54例ASD均为中央型，合并肺动脉高压12例，合并其他疾病7例，其中二尖瓣狭窄、二尖瓣脱垂合并关闭不全、脑栓塞、血友病、高血压病、室间隔缺损、动脉导管未闭各1例。54例患者术前、术后常规行TTE检查、胸部X线平片、12导联心电图及右心导管检查。术中均用TTE和TEE监测。结果54例患者均成功地行介入治疗ASD，技术成功率100％。闭合器型号10-40mm，无任何并发症。5例患者（3例室上性心动过速、1例室性心动过速、1例频发室性早搏）先行射频消融术，而后成功闭合ASD。结论ASD合并心律失常介入治疗，必须特殊对待心律失常，认真掌握各种心律失常治疗原则，而后介入治疗ASD。

Objective To reported the clinical experience in patients with foramen secundum atrial septal defect （ASD） combined with arrhythmia which were treated by interventional therapy. Methods Among 54 patients, 20 patients were with atrial fibrillation, 10 with frequently premature ventricular contraction, 4 with frequently premature atrial contraction, 3 with supraventricular tachycardia, 1 with ventricular tachycardia, 14 patients with Ⅰ °AVB, 1 with Ⅱ° AVB and 1 with Ⅲ°AVB. All 54 patients were central type foramen secundum ASD. Twelve patients combined with pulmonary artery hypertension and 7 patients combined with other diseases which included MS, MP and MI, cerebral embolism, bleeder＇s disease, hypertensive disease, VSD, PDA respectively. Fifty-four patients were all examined with TTE, breast X-ray, 12 leads ECG, right heart catheter check in pre-operation and post-operation, monitored with TTE and TEE in the operation. Results All 54 patients were successfully cured by interventional therapy without complication, the success rate was 100%. The type of occluder was from 10 mm to 40 mm. Five patients （3 with supraventricular tachycardia, 1 with ventricular tachycardia, 1 with frequently premature ventricular contraction） were cured by radio-frequency ablation at first, then were closed ASD successfully. Conclusion About the interventional therapy of ASD combined with arrhythmia, we should treat arrhythmia specially and master the therapeutic principle seriously.