心腔内三维超声辅助下经导管射频消融治疗心房颤动伴造影剂不相容患者的临床分析

Feasibility and Outcomes of Intracardiac Echocardiography Guided Radiofrequency Ablation of Atrial Fibrillation Patients With Contrast Agents Incompatibility

目的:探讨心腔内三维超声辅助下经导管射频消融治疗心房颤动伴造影剂不相容患者的安全性及临床疗效。方法:选择2015年1月至2017年1月期间中国医学科学院阜外医院收治的16例心房颤动伴造影剂不相容的患者。患者均未行左心房、肺静脉CT和造影,在心腔内三维超声辅助下建立左心房及肺静脉三维模型,并指导穿刺房间隔和消融导管在心脏内的操作。结果:15例患者顺利完成心房颤动射频消融,平均手术时间(96.0±14.3)min,透视时间(6.1±1.2)min,X线透视剂量(115.8±49.3)mGy,未发生心脏压塞、脑栓塞、左心房-食道瘘、肺静脉狭窄及动脉瘤等并发症及死亡。1年随访结果显示,9例患者维持窦性心律,其中阵发性心房颤动7例,持续性心房颤动2例。结论:对于心房颤动伴造影剂不相容的患者,心腔内三维超声可以替代经食道超声心动图,避免左心房造影及增强CT检查;心腔内三维超声不延长手术时间,显著减少X线曝光时间及剂量,可避免穿刺房间隔的并发症,提高穿刺准确性。

Objectives:To investigate the safety and clinical efficacy of intracardiac echocardiography-guided transcatheter radiofrequency ablation for atrial fibrillation patients with contrast media incompatibility.Methods:16 patients,who admitted to Fuwai Hospital,Chinese Academy of Medical Science with atrial fibrillation and contrast incompatibility from January 2015 to January 2017,were selected.Left atrial and pulmonary vein CT and angiography were not performed in these patients.Three-dimensional reconstruction of left atrium and pulmonary vein was established based on intracardiac echocardiography data,and used to guide the interatrial septum puncture and ablation process.Results:Radiofrequency ablation was successfully performed in 15 out of 16 patients,the average operation time was(96.0±14.3)min,the average fluoroscopy time was(6.1±1.2)min,and the average X-ray fluoroscopy dose was(115.8±49.3)mGy.There were no complications such as cardiac tamponade,cerebral embolism,left atrial esophageal fistula,pulmonary vein stenosis,aneurysm and death.One-year follow-up results showed that sinus rhythm was maintained in 9 patients,including 7 patients with paroxysmal atrial fibrillation and 2 patients with persistent atrial fibrillation.Conclusions:For atrial fibrillation patients with contrast media incompatibility,intracardiac echocardiography can not only replace the role of transesophageal echocardiography on detecting intra cardiac thrombus but also supply useful information usually obtained from left atrial angiography and enhanced CT angiography.It does not prolong operation time,and could significantly reduce the X-ray exposure time and dose.What’s more,it can also help avoid the complications of interatrial septum puncture。