患者女性,22岁,因"反复晕厥5年"入院.术前心电图提示窦性心动过缓(49次/分),心脏超声、头颅/胸部C T及实验室检查均未见明显异常.直立倾斜试验中患者诱发晕厥,心电图见近15 s窦性停搏,提示血管迷走性晕厥(心脏抑制型).随后进行心脏自主神经节导管消融术,术后症状明显改善,随访2个内月未再出现晕厥相关症状,复查直立倾斜试验为阴性.

Background:The present study investigated the safety and efficacy of mapping and ablating isolated premature atrial contractions (PACs) in patients with a structurally normal heart, as well as whether the elimination of PACs by radiofrequency catheter ablation (RFCA) improved symptoms and the quality of life.Methods:Forty-three consecutive patients with frequent, symptomatic, and drug-refractory PACs, but without atrial tachyarrhythmias (≥5 beats), were enrolled. In all patients, we performed physical, laboratory, and imaging examinations to exclude structural heart disease. The quality of life questionnaire SF-36 before and 3 months after RFCA was performed in each patient.Results:Twenty-three men and 20 women with an average age of 52.6 ± 17.6 years were finally enrolled. The mean number of PACs was 21,685 ± 9,596 per 24 h, and the mean PACs' burden was 28.9 ± 13.7%. Short runs of tachycardia (<5 atrial beats) were observed in 32 patients (74.4%). All patients underwent successful RFCA without complications. The activation time at the successful ablation sites preceded the onset of the P-wave by 36 ± 7.6 ms. During 15 ± 8 months of follow-up, the recurrence of PACs was observed in 2 patients. The 24-h PAC burden was significantly reduced 3 months after RFCA (mean 0.5%, p < 0.05). The quality of life scores were significantly increased 3 months after RFCA (all p < 0.05).Conclusions:RFCA was feasible, safe, and effective to eliminate isolated frequent, symptomatic, and drug-refractory PACs in patients with a structurally normal heart. The elimination of PACs by RFCA significantly improved symptoms and the quality of life.

国内外研究表明Marshall静脉(V O M)无水乙醇消融可提高持续性心房颤动导管消融的远期成功率.VOM无水乙醇消融的规范操作对提高手术成功率及减少并发症至关重要.VOM无水乙醇消融规范包括术前准备、手术操作、解剖变异的处理、注意事项及相关说明以及安全性.

患者男性,55岁,因"心房颤动消融术后2个月,心悸1周"入院.心电图提示不典型心房扑动.经胸超声心动图示:左房3.8 cm,右房4.3cm,左室4.8cm,左室射血分数0.78.三维电生理激动标测示左房激动呈放射样扩布,且存在色块及标测周长缺失.于M arshall静脉内植入微电极拖带标测良好,随后于M arshall静脉内行无水乙醇化学消融终止心房扑动,再未诱发.