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目的:认识心房颤动(房颤)导管消融术的另一种并发症——急性心力衰竭(心衰)。方法:回顾分析12例既往无心力衰竭史、因房颤经导管消融术后早期发生急性心衰患者的临床资料。结果:1032例房颤导管消融术后48h内发生急性心衰12例(1.2%),12例中慢性房颤11例,阵发性房颤1例。临床表现为呼吸急促12例(100%),其中端坐呼吸8例(67%),剧烈胸痛2例(17%),发热(37.5℃～38.5℃)6例(50%),肺部湿性啰音12例(100%),心室率增快12例(100%),低血压1例(8%),胸片提示胸腔积液3例(25%)、肺水肿改变4例(33%),经胸超声心动图提示少量心包积液5例(42%),白细胞计数大于10.0×109/L7例(58%),左室射血分数(59.6±3.2)%。所有患者于治疗后2～7d内临床症状消失。结论:房颤导管消融术后早期可能会发生心衰,合理的支持治疗可在短期内改善病情。
OBJECTIVES: To recognize another complication of catheter ablation of atrial fibrillation (atrial fibrillation) - acute heart failure (heart failure). Methods: The clinical data of 12 patients with no previous history of heart failure and acute heart failure in the early stage after atrial fibrillation by catheter ablation were retrospectively analyzed. Results: Acute heart failure occurred in 12 cases (1.2%) within 10 hours after catheter ablation in 1032 patients. There were 11 cases of chronic atrial fibrillation and 1 case of paroxysmal atrial fibrillation in 12 cases. The clinical manifestations were 12 cases (100%) with shortness of breath, including 8 cases (67%) of sitting breathing, 2 cases of severe chest pain (17%), 6 cases of fever (37.5 ℃ ~ 38.5 ℃) 12 cases (100%) with rales, 12 cases (100%) with fast ventricular rate and 1 case (8%) with hypotension. Chest radiography showed pleural effusion in 3 cases (25%) and pulmonary edema in 4 cases (33% ). Transthoracic echocardiography showed a small amount of pericardial effusion in 5 cases (42%), white blood cell count of more than 10.0 × 109 / L in 7 cases (58%) and left ventricular ejection fraction (59.6 ± 3.2%). All patients disappeared within 2 ~ 7 days after treatment. CONCLUSION: Heart failure may occur early after ablation of atrial fibrillation catheter. Reasonable supportive care may improve the condition in a short period of time.