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Circulation：左心室射频消融增加脑栓塞风险！

2017-07-21 MedSci MedSci原创

左心室射频消融脑栓塞
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导管消融治疗室性心动过速和室性早搏 (pvc)是常见的。导管消融治疗心房纤颤可能增加脑栓塞的发生风险，这是由于心脏复律以及左心房低流速中存在的大量的消融病变所导致，但是心室消融的脑栓塞风险目前并没有得到评估。

背景:导管消融治疗室性心动过速和室性早搏 (pvc)是常见的。导管消融治疗心房纤颤可能增加脑栓塞的发生风险，这是由于心脏复律以及左心房低流速中存在的大量的消融病变所导致，但是心室消融的脑栓塞风险目前并没有得到评估。

方法:在9个月的时间内，研究者纳入了18名患者，他们的纳入标准是室性心动过速或PVC行消融治疗。左室(LV)消融的患者与只接受右室消融的对照组相比较。排除那些植入心脏除颤器或永久起搏器的患者。射频消融被用于所有的病例，肝素的使用使得所有接受左心室消融的活化的凝血酶原时间达到300 - 400秒。在消融后的一个星期内，对每个病人进行了脑核磁共振检查。

结果:平均年龄为58岁，一半患者为男性，一半人有高血压病史，大多数人没有已知的血管疾病或心力衰竭。12例患者(室性心动过速，n = 2;PVC,n = 10)接受左心室消融和6例患者接受右心室消融(室性心动过速，n = 1;PVC,n = 5)。7例患者(58%)接受LV消融的患者有16个脑梗塞灶，而与之相比右心室消融者为0 (P = 0.04)。11例患者中有7例(63%)接受治疗，至少有1例新的脑损伤出现。

结论:超过一半的患者在接受常规的LV消融治疗过程(主要是PVC切除术)后，经历了新的脑栓塞。未来的研究对于了解这些病变的长期影响，并确定避免它们的最佳策略是至关重要的。



原文出处：
Whitman IR, Gladstone RA, Badhwar N，et al. Brain Emboli After Left Ventricular EndocardialAblation.Circulation. 2017 Feb 28;135(9):867-877. doi: 10.1161/CIRCULATIONAHA.116.025546.

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    2017-07-23 jinweidong

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    2017-07-23 xiangyuzhou972

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