心房颤动射频消融术后早期左心房僵硬综合征临床特点

Clinical characteristics of early stiff left atrial syndrome after ablation of atrial fibrillation

目的分析心房颤动(房颤)射频消融术后早期左心房僵硬综合征的临床特点,探讨其出现的可能原因,预防避免类似事件的发生。方法回顾性分析2017年11月至2018年12月在北京医院行房颤射频消融术后早期出现左心房僵硬综合征的患者,搜集血清学指标、超声心动图及射频消融术式等临床资料并随访12个月内是否再住院及房颤复发等情况。结果281例行房颤射频消融术患者中,5例出现急性左心房僵硬综合征的表现,年龄均≥75岁,其中男2例。术后均出现呼吸困难、不能平卧,X线胸片示肺水肿,血脑钠肽均>150 pg/ml,超声心动图示肺动脉收缩压33~77 mmHg(1 mmHg=0.133 kPa),出现时间为术后1~3 d。经利尿等对症治疗,均于1周内好转。平均随访12个月,均无再住院事件发生。结论房颤射频消融术后早期左心房僵硬综合征有一定的发生率,但经过适当治疗恢复良好,长期预后亦较好。

Objective To investigate the clinical characteristics,prevalence and potential causes of early stiff left atrial syndrome(SLAS)after radiofrequency catheter ablations(RFCA)of atrial fibrillation(AF).Methods A retrospective analysis of early SLAS incidence in AF patients who underwent RFCA,from November 2017 to December 2018 was performed in Beijing Hospital.Clinical data such as serological indicators,echocardiography and radiofrequency ablation were collected,and followed up for rehospitalization and recurrence of AF within 12 months.Results Five cases of early SLAS occurred after RFCA in a total of 281 AF patients.All the five patients were over 75 years old,including 2 males.The symptoms included dyspnea,difficulty of lying down,edema in the lung by X-ray analysis,plasma B-type natriuretic peptide(BNP)>150 pg/ml,and pulmonary arterial systolic pressures 33-77 mmHg(1 mmHg=0.133 kPa)in the echocardiography.All SLAS cases occurred 1-3 days post-ablation.With diuretics treatment,all 5 patients’symptoms were improved within 1 week.In the 12 months follow-up,all 5 patients’conditions remained stable at NYHA classⅠand no rehospitalizations.Conclusion There is a certain incidence of early SLAS after RFCA of AF,but it has a good recovery after appropriate treatment and a good long-term prognosis.