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目的报道经导管消融治疗发生于肥厚梗阻性心肌病(HOCM)患者的阵发性心房颤动(房颤)的初步结果。方法6例HOCM患者,均伴有发作频繁、症状明显并且抗心律失常药物治疗无效的阵发性房颤,其中男性4例,女性2例,年龄43~66(53·8±8·8)岁。在三维电解剖标测和同侧肺静脉环状标测联合指导下行环绕两侧肺静脉的线性消融。消融终点为双侧肺静脉的电学隔离。结果6例患者术中均达到消融终点。1例于术后第2个月时因复发房性心动过速(房速)而接受了第2次环肺静脉线性消融治疗。随访4~14(9·2±3·4)个月后,6例患者均未再发作房颤,其中4例未服用任何抗心律失常药物,2例需口服胺碘酮治疗。无任何操作相关并发症。结论对于发生于HOCM患者的阵发性房颤,如果抗心律失常药物治疗无效,三维标测系统指导下的环肺静脉线性消融术是一项可供选择的治疗措施。
Objective To report preliminary results of paroxysmal atrial fibrillation (AF) in patients with hypertrophic obstructive cardiomyopathy (HOCM) treated with catheter ablation. Methods Six patients with HOCM were accompanied by paroxysmal atrial fibrillation with frequent seizures and obvious symptoms and ineffective anti-arrhythmic drugs treatment. There were 4 males and 2 females, ranging in age from 43 to 66 (53.8 ± 8.8) year old. In the three-dimensional electroanatomical mapping and ipsilateral pulmonary vein mapping to guide the downlink around the pulmonary vein on both sides of the linear ablation. The end point of ablation is the electrical isolation of the bilateral pulmonary veins. Results All 6 patients reached the end of ablation during operation. One case received a second circumferential pulmonary vein ablation for recurrent atrial tachycardia (atrial tachycardia) at the second month after surgery. After 4 to 14 (9.2 ± 3.4) months of follow-up, none of the 6 patients had atrial fibrillation, 4 of whom did not take any anti-arrhythmic drug and 2 required oral amiodarone. No operation-related complications. Conclusions For paroxysmal atrial fibrillation in patients with HOCM, circumferential pulmonary vein ablation under the guidance of a three-dimensional mapping system is an alternative treatment if antiarrhythmic drug therapy is ineffective.