心腔内超声三维标测指导下经皮射频消融室间隔治疗肥厚型梗阻性心肌病

Radiofrequency ablation of interventricular septum to treat hypertrophic obstructive cardiomyopathy with CARTOSound technology

目的:探讨心腔内超声三维标测指导下射频消融室间隔治疗肥厚型梗阻性心肌病的安全性及疗效。方法:20例肥厚型梗阻性心肌病患者,应用心腔内超声三维标测技术重建左心室腔,以收缩期二尖瓣瓣叶前向运动(SAM)对应的左室间隔部位作为消融靶点,消融能量35 W,冷盐水灌注流速17 mL/min,温度43℃,每次放电时间40-60 s。以左室流出道压差下降50%作为消融有效终点。比较术前、术后左室流出道压差及6 min步行试验结果,记录围术期并发症发生情况,评价疗效和安全性。结果:消融前室间隔厚度(20.3±1.9)mm,左室流出道压差(106.0±36.5)mmHg(1 mmHg=0.133 kPa),6 min步行试验(404.2±25.6)m。消融放电(5.6±0.9)次,左室流出道压差降至(44.0±35.2.mmHg,术中一过性左束支传导阻滞3例。术后6个月随访,左室流出道压差(28.4±12.9)mmHg,6 min步行试验(525.0±25.2.m,较消融前明显改善(P<0.001)。结论:经心腔内超声指导下室间隔射频消融术治疗肥厚型梗阻性心肌病安全、有效。

Aim:To evaluate the efficacy and security of radiofrequency ablation of the interventricular septum to treat hypertrophic obstructive cardiomyopathy with CARTOSound technology.Methods:Twenty patients with hypertrophic obstructive cardiomyopathy were observed.With the guidance of intracardiac echocardiography,left ventricular chamber was reconstructed.The mitral valve systolic anterior motion contacting septal area was annotated on the ventricular chamber and was targeted for ablation region.Ablation energy was 35 W,flow rate of cold brine infusion was 17 mL/min,the temperature was 43℃,and the discharging time was 40-60 s per time.A gradient reduction of>50%was designed as therapeutic end point.Echocardiography examination(gradient reduction)and six-min walk test were performed at 6 months after ablation.Results:Before ablation,septal thickenss was(20.3±1.9)mm,the left ventricular gradient reduction was(106.0±36.5)mmHg,six-min walk test was(404.2±25.6)m.After(5.6±0.9)radiofrequency release,left ventricular gradient reduction was decreased to(44.0±35.2.mmHg.Three patients experienced left bundle branch transit block.The follow-up at 6 months after ablation showed that left ventricular gradient reduction was(28.4±12.9)mmHg,and six-min walk test was(525.0±25.2.m,both were improved(P<0.001).Conclusion:Radiofrequency ablation of the interventricular septum to treat hypertrophic obstructive cardiomyopathy with CARTOSound technology is effective and safe.