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目的:研究心律失常射频消融术并发心脏压塞的临床特点及处理转归,并探讨更有效的处理措施。方法:回顾性分析南京医科大学第一附属医院心血管内科2009年1月～2011年8月实施射频消融术患者共2 472例,其中13例发生心脏压塞(男7例,女6例,年龄37～73岁),均为房性心律失常或者室性心律失常射频术中或术后发生。结果:660例房性心律失常消融术中/术后有9例发生心脏压塞,279例室性心律失常消融术中有4例发生心脏压塞。13例心脏压塞均进行心包穿刺引流,其中有4例经引流仍不能稳定而行开胸修补术。根据患者消融过程及开胸术中所见,共5例可确定心脏破裂的部位,分别在左心房顶部、右房前壁、左心耳及右室流出道游离壁。在抢救过程中应用自体血回输技术,最多者回输2 550 ml,无1例发生相关血液系统并发症。所有患者经抢救后均恢复良好。结论:复杂心律失常的射频消融中心脏压塞的发生率显著高于普通室上性心动过速。在其抢救过程中应用自体回输血技术是安全的。由于解剖组织的原因,心脏压塞有相对的易发部位,在这些部位进行消融应该特别注意。
Objective: To study the clinical characteristics of arrhythmia radiofrequency ablation combined with cardiac tamponade and the treatment of prognosis, and to explore more effective treatment measures. Methods: A retrospective analysis of Cardiovascular Medicine, First Affiliated Hospital of Nanjing Medical University from January 2009 to August 2011 a total of 2 472 patients undergoing radiofrequency ablation, of which 13 cases of cardiac tamponade (7 males and 6 females, Age 37-73 years), are atrial arrhythmia or ventricular arrhythmia radiofrequency or postoperative. RESULTS: Totally 9 cases of cardiac arrhythmia occurred during / after ablation of 660 cases of atrial arrhythmia, and 4 cases of cardiac arrhythmia occurred in 279 cases of ventricular arrhythmia ablation. Thirteen cases of cardiac tamponade were pericardiocentesis drainage, of which 4 cases of drainage can not be stable and thoracic repair. According to the patient’s ablation process and thoracotomy seen in a total of 5 cases can determine the location of heart rupture, respectively, in the top of the left atrium, right atrial anterior wall, left atrial appendage and right ventricular outflow tract free wall. Application of autologous blood transfusion in the rescue process, the maximum number of transfusion 2 550 ml, no one occurred related to complications of the blood system. All patients recovered well after rescue. CONCLUSIONS: The incidence of cardiac tamponade during radiofrequency ablation of complex arrhythmias is significantly higher than that of common supraventricular tachycardia. It is safe to use autologous blood transfusion in the rescue process. Due to anatomical reasons, cardiac tamponade has a relatively vulnerable site, ablation in these areas should pay special attention.