肥厚型心肌病合并心房颤动的射频导管消融治疗

Catheter ablation of atrial fibrillation in patients with hypertrophic cardiomyopathy

目的评价肥厚型心肌病合并心房颤动（房颤）射频导管消融的安全性和疗效。方法入选2005年至2012年共57例肥厚型心肌病合并房颤患者，采用Carto三维标测系统引导环肺静脉消融电隔离术，附加二尖瓣、三尖瓣峡部线性消融及左心房碎裂电位消融以改良基质。结果57例患者均顺利完成导管消融术，平均手术时间（192±36）min，X线曝光时间（28±8）min，随访时间（3．1±2．0）年，单次消融成功率42．1％，多次消融成功率61．4％，其中梗阻性肥厚型心肌病患者消融成功率36．4％，非梗阻性患者成功率67．4％（P=0．031）。结论环肺静脉消融结合基质改良治疗肥厚型心肌病合并房颤在有经验的治疗中心安全有效。

Objective The aim of this study is to evaluate the safety and effects of catheter ablation in atrial fibrillation （AF） patients with hypertrophic cardiomyopathy （HCM）. Methods Fifty-seven AF patients with HCM from 2005 to 2012 undergoing catheter ablation were enrolled.The ablation strategy was circumferen- tial pulmonary vein isolation with additional linear ablations（ the mitral isthmus ablation and cavotricuspid isth- mus ablation） and complex fractionated atrial electrograms （CFAE） ablation guided by a 3-dimensional map- ping system （Carto）.Results Fifty-seven patients underwent catheter ablation.The mean procedure time was （192±36） min, and the mean X-ray fluoroscopic time was （ 28 ± 8） min. During the 3-year follow-up, after the first ablation procedure,sinus rhythm was documented in 24 of 57 （42. 1%） patients. After multiple proce- dures, sinus rhythm was maintained in 35 of 57 （61.4%） patients.67. 4% patients with non-obstructive HCM maintained sinus rhythm, while the success rate was only 36. 4% in patients with obstructive HCM （P = 0. 031 ）. Conclusions Catheter ablation in AF patients with HCM in experienced centers is safe and efficient.