射频消融治疗器质性心脏病室性心动过速的严重并发症分析与处理-赵李颜

DOI10.3969/[e-mail]··【】、、。200982015842、。42502822。37.1%1111。。【】【】Ｒ541．71AnalysisofseverecomplicationsofcatheterablationforventriculartachycardiainpatientswithstructuralheartdiseasesZHAOLi-yanZHANGFeng-xiangFANGZhenYANGBingCHENHong-wuJUWei-zhuGUKaiYANGGangLIMing-fangCAOKe-jiangCHENMing-long.DepartmentofCardiologytheFirstAffiliatedHospitalofNanjingMedicalUniversityJiangsuProvincePeople'sHospita[e-mail]【Abstract】ObjectiveToanalyzetheseverecomplicationsoccuredduringpuncturemappingandablationforventriculartachycardiaVTinpatientswithstructuralheartdiseasesinordertoimprovetheunderstandingoftheseverecomplicationsandtheirmanagement.MethodsFromAugust2009toAugust201542patientswithstructuralheartdiseasesandVTwhoacceptedepicardialmappingandablationofVTinJiangsuprovincepeople'shospitalwereretrospectivelyanalyzed.Thepossiblecausesofcomplicationstreatmentstrategyandtheirevolutionwerestudied.ＲesultsAtotalof50mappingandablationprocedureswereperformedinthe42patientsedocardialmappingandablationfor28timesandepicardalandedocardialmappingandablationfor22times.37.14%patientssufferedfromseverecomplicationsduringprocedure.PhrenicnerveinjuryPNIafterepicardialablationhappenedin1patientwithidiopathicepicardialscarVTanditrecoveredspontaneouslyafteronemonth.Pericardialtamponadeduerightventricularruptureoccurredduringepicardialablationin1patientwithDCMwhoreceivedrightventriclerepairbyemergentsurgery.Liverhematomaoccurredin1cardiacsarcoidosispatientwithVTduringpericardiumpunctureandwastreatedbytargetsmallhepaticarteryembolizationanddrainage.ConclusionsComplicationsofepicardialmappingandablationofVTforstructuralheartdiseasescouldhardlybecompletelyavoidedstandardizedprocedurecanreducecomplicationsandtimelyrecognitionandtreatmentofcomplicationscanhelptoavoidsevereconsequence．【Keywords】VentriculartachycardiaEpicardialablationCardiactamponadeComplications·396·2015122312ChinJInterventCardiolDecember2015Vol23No.12、implantablecardioverterdiffibrillatorICD1-2。、。。、、、3。2009820158。11.120098201584238446.7±16.2。42dilatedcardiomyopathyDCM33arrthythmogenicrightventricularcardiomyopathyAＲVC5ischemiccardiomyopathyICM4leftventricularejectionfractionLVEF53±14%。1.21.2.1ICD。410。400ms300ms310ms200ms。、。。。1.2.2、X8F。CAＲTONavX。。2ms×10mA。40W43℃30ml/min。。。。ICD。242502822。31。168NYHAⅡLVEF45%20137ICD。ICD2014716、。CAＲTO3。X1000ml1。。β、ACEI。13.3ICD。229NYHAⅠLVEF60%20109ICD。ICD20115、。。1316813.322952.0345+5.8·496·2015122312ChinJInterventCardiolDecember2015Vol23No.12X。11。β、ACEI。52.0ICD。345NYHAⅠLVEF60%20147ICD。ICD201515、。CT2。。。β、ACEI。5.8ICD。1123CT3。、、4。ICM。phrenicnerveinjuryPNI5-7。。PNI8-9。PNI。PNI。。、110。4mm。、、、、。、X。。11。140W43℃30ml/min。、4。3BCT。、。1．．20151915-18．2．．20132134-40．3．．2003101149-1151．4SarkozyATokudaMTedrowUBetal．Epicardialablationofventriculartachycardiainischemicheartdisease．CircArrhythmElectrophysiol201361115-1122．5KilluAMFriedmanPAMulpuruSKetal．Atypicalcomplicationsencounteredwithepicardialelectrophysiologicalprocedures．HeartＲhythm2013101613-1621．6．．201422538-540．7SosaEScanavaccaMd'AvilaAetal．Anewtechniqueto·596·2015122312ChinJInterventCardiolDecember2015Vol23No.12performepicardialmappingintheelectrophysiologylaboratory．JCardiovascElectrophysiol19967531-536．8Sánchez-QuintanaDCabreraJAClimentVetal．HowclosearethephrenicnervestocardiacstructuresImplicationsforcardiacinterventionalists．CardiovascElectrophysiol200516309-313．9．．20116470-472．10PeichlPWichterleDPavluLetal．Complicationsofcatheterablationofventriculartachycardiaasingle-centerexperience．CircArrhythmElectrophysio20147684-690．11．．20061454．2015-10-09····、、《》。、、、、、、、、。《》http//zjxb.cbpt.cnki.net“”→→→“”“”→→→、→→“”。50100。→“”→“”。。。。。010－5773014283572299·696·2015122312ChinJInterventCardiolDecember2015Vol23No.12