心房颤动导管消融术后早期心力衰竭12例临床分析

Early heart failure after catheter ablation for atrial fibrillation

目的:认识心房颤动(房颤)导管消融术的另一种并发症——急性心力衰竭(心衰)。方法:回顾分析12例既往无心力衰竭史、因房颤经导管消融术后早期发生急性心衰患者的临床资料。结果:1032例房颤导管消融术后48h内发生急性心衰12例(1.2%),12例中慢性房颤11例,阵发性房颤1例。临床表现为呼吸急促12例(100%),其中端坐呼吸8例(67%),剧烈胸痛2例(17%),发热(37.5℃～38.5℃)6例(50%),肺部湿性啰音12例(100%),心室率增快12例(100%),低血压1例(8%),胸片提示胸腔积液3例(25%)、肺水肿改变4例(33%),经胸超声心动图提示少量心包积液5例(42%),白细胞计数大于10.0×109/L7例(58%),左室射血分数(59.6±3.2)%。所有患者于治疗后2～7d内临床症状消失。结论:房颤导管消融术后早期可能会发生心衰,合理的支持治疗可在短期内改善病情。

Objective：To describe a new complication after catheter ablation for atrial fibrillation（Af）. Method： Retrospectively analyze the clinical data of early heart failure after catheter ablation for Af from January in 2006 to December in 2007. Result：The 12（1.2%） of 1032 patients（ 9 males, mean age [66±7] years ）, composed of 1 paroxysmal Af and 11 chronic Af, were enrolled due to heart failure during 48h after catheter ablation for Af. The common symptoms were as follows： dyspnea in 12 （100%）, orthopnea in 8（67%）, intense thoracalgia in 2 （17%）, fever in 6（50%）, pulmonary tales in 12（100%）, inceasing heart rate in 12（100%）, hypotension in 1 （8 %）, pleural effusion in 3 （25%）, pulmonary edema signs on sternum in 4 （33%）, mild pericardial effusion in 5 （62%）, white blood cell count more than 10.0×10^9/L in 7 （58%）and left ventricular ejection fraction （59.6±3.2） % in all patients. Clinical symptoms resolved by 2-7 d rational treatment. Conclusion： Patients undergoing catheter ablation for Af are at risk for heart failure during early phase after intervention. With supportive therapy, this complication appears to be well-manageable within a short-term.