妊娠合并快速心律失常孕妇行心脏射频消融术治疗的临床分析

Clinical analysis of 19 cases of pregnant women with rapid arrhythmia in the treatment of radiofrequency catheter ablation

目的探讨妊娠合并快速心律失常孕妇在妊娠期行心脏射频消融术治疗的疗效及其对母儿结局的影响。方法收集2002年1月—2016年3月首都医科大学附属北京安贞医院收治的19例妊娠合并快速心律失常行心脏射频消融术治疗孕妇的临床资料，回顾性分析其临床特点、治疗及母儿结局。结果（1）临床特点：19例孕妇的年龄为26—35岁，平均（31±4）岁；发病孕周为15～32周，平均（21±4）周；临床表现：主要为阵发性心悸、胸闷、头晕、视物模糊；心律失常类型：心房扑动＋房性心动过速1例，心房扑动＋心房颤动1例，心房颤动1例，室上性心动过速3例，房性心动过速＋室上性心动过速1例，室性心动过速4例，室性早搏＋室性心动过速3例，房性心动过速5例。19例孕妇均进行过药物治疗，但均失败，其中2例还进行了食管调搏和电复律治疗，也均失败。（2）治疗：19例孕妇经过心脏射频消融术治疗后，心律失常完全终止，其中前7例孕妇（2002-2014年）在少量放射线的引导下进行手术，后12例孕妇（2015年及以后）是在EnsiteNavX维标测系统下进行，为零射线。并发症和不良反应：1例手术结束时出现宫缩，给予硫酸镁静脉滴注3d抑制宫缩；1例出现迷走神经反射引起的血压降低，给予补液后血压正常。（3）母儿结局：19例孕妇心脏射频消融术后均存活；除1例孕妇放弃继续妊娠行中期引产外，其余18例孕妇均足月分娩，其中4例孕妇阴道分娩，14例孕妇剖宫产术分娩。存活儿随访1～14年，平均（2．0±2．9）年，随访期内婴幼儿发育良好。结论心脏射频消融术对妊娠合并心律失常的孕妇是1种安全、有效的治疗方法，可达到根治快速心律失常的目的。

Objective To investigate the risk of radiofrequency catheter ablation and maternal and infant in pregnant women with rapid arrhythmia during pregnancy. Methods The clinical data of the 19 cases of pregnancy complicated with rapid arrhythmia were retrospectively analyzed and followed up, including the gestational week, the type of arrhythmia, the treatment, and the outcome of the mother and child in Beijing Anzhen Hospital of Capital Medical University from January 2002 to March 2016. Results （1） Clinical characteristics： the ages of the 19 cases were （31 ±4） years old （ranged from 26 to 35 years old）, the onset gestational ages were （21±4） weeks （ranged from 15 to 32 weeks）. Clinical symptoms： paroxysmal palpitation, chest tightness, dizziness, and blurred vision. Arrhythmia types： 1 case of atrial flutter and atrial tachycardia, 1 case of atrial flutter and atrial fibrillation, 1 case of atrial fibrillation, 3 cases of supraventricular tachycardia, 1 case of atrial tachycardia and supraventricular tachycardia, 4 cases of ventricular tachycardia, 3 cases of ventricular premature beats and ventricular tachycardia, and 5 cases of atrial tachycardia. All cases were treated by drugs, but all failed 2 cases of them were performed esophageal pacing and cardioversion and also failed. （2） Treatment plan： 19 cases after treatment of arrhythmia, completely terminated, the first 7 patients （from 2002 to 2014） were operated in a small amount of radiation under the guidance, the other 12 patients （after 2015） were carried out in the Ensite NavX mapping system, whichwere operated with zero radiation. Complications and adverse reactions： 1 case of uterine contraction end operation and was gived magnesium sulfate 3 days intravenous inhibition of uterine contractions, 1 case occurred vagal reflex caused by reduced blood pressure and was gived fluid infusion utill normal blood pressure. （3） Maternal and neonatal outcomes： in addition 1 case of pregnancy to give up, the remaining 18 cases were full-term pregnant women, including 4 cases of vaginal delivery and 14 cases of cesarean section. The survival neonates were followed up for 1 to 14 years, average （2.0 ± 2.9） years. The infants were well developed during the follow-up period. Conelution Radinfrequency catheter ablation is a safe and effective method for the treatment of pregnancy complicated with rapid arrhythmia.