心房颤动射频消融致心脏损伤后综合征的临床分析

Clinical analysis of postcardiac injury syndrome after radiofrequency catheter ablation for atrial fibrillation

目的了解心房颤动射频消融术后心脏损伤后综合征(PCIS)的易患因素及临床特点,为临床及早诊断和治疗提供依据。方法回顾性分析1 528例心房颤动射频消融术后患者,超声心动图检查确定新发心包积液和(或)胸腔积液15例,其中6例确诊为继发于心房颤动射频消融术后的PCIS。结果与无PCIS的患者比较,PCIS患者的年龄较大[(68.3±7.8)岁比(51.3±13.2)岁,t=2.180,P=0.006 2],合并高血压的比例高(83.3%比11.1%,P=0.011),且住院时间明显延长[(24.2±6.8)d比(11.4±5.5)d,t=2.896,P=0.035 7]。在6例PCIS患者中,射频消融术后均出现发热,并可探测到胸腔积液,双侧较多见(4例),单侧主要见于左侧(2例)。结论在心房颤动射频消融术后出现胸腔积液和(或)心包积液的部分患者可进一步进展成为PCIS,其中高龄或伴高血压的患者出现PCIS的可能性更大,其早期临床特点主要表现为发热和胸腔积液。

Objective To study the risk factors and clinical features of postcardiac injury syndrome （PCIS） after ablation of atrial fibrillation and provide a basis for its diagnosis and therapy. Methods This retrospective study enrolled 1 528 patients with atrial fibrillation who underwent radiofrequency ablation, including 15 patients with new pericardial effusion and/or pleura1 effusion were confirmed by echocardiography, of which 6 patients were diagnosed with PCIS secondary to radiofrequency ablation of the atrial fibrillation. Results Compared with patients without PCIS,patients with PCIS were older [ （63.8 ± 7.8 ） years vs. （ 51.3 ±13.2 ） years, P = 0. 006 2 ], and were more likely accompanied by hypertension （ 83.3 % vs. 11.1%, P = 0. 011 ） and had a prolonged hospitalization time [ （24. 2 ± 6. 8 ） days vs. （ 11.4 ± 5.5 ） days, P = 0. 035 7 ]. All the 6 cases with PCIS had a fever, and pleural effusion could be detected after ablation, of which bilateral pleural effusion was predominant（4 cases）and unilateral was mainly in left side （2 cases）. Conclusions Some of the patients who developed with pericardial effusion and/or pleural effusion after ablation procedure may progress to PCIS, most of whom have elder age or suffered from hypertension. PCIS is usually characterized by early onset of fever and pleural effusion.