Roberts-Thomson Kurt C, Steven Daniel, Seiler Jens, Inada Keiichi, Koplan Bruce A, Tedrow Usha B, Epstein Laurence M, Stevenson William G
Cardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115, USA.
Circulation. 2009 Oct 13;120(15):1465-73. doi: 10.1161/CIRCULATIONAHA.109.870790. Epub 2009 Sep 28.
Currently, only anecdotal information exists on the presentation and outcome of coronary arterial injury after ablation procedures.
Four patients who sustained coronary artery injury of a cohort of patients undergoing 4655 consecutive ablation procedures (0.09%) are described. The patients' mean age was 45+/-11 years, and 1.8+/-0.5 prior ablation attempts had been unsuccessful. Coronary injury occurred from epicardial ventricular tachycardia ablation in 2 patients (irrigated radiofrequency ablation in one and cryoablation in the other) and ablation within the middle cardiac vein with irrigated radiofrequency in 2 patients. All involved branches of the right coronary artery. Acute occlusion presenting with ST-segment elevation immediately after ablation was recognized during the procedure in 2 cases. Occlusion failed to respond to nitroglycerin or balloon dilation, and stenting was required in both cases. Acute myocardial infarction occurred 2 weeks after epicardial ablation as a result of occlusion of a right ventricular branch of the right coronary artery giving rise to the posterior descending coronary artery in 1 patient. A moderate asymptomatic stenosis was seen on angiography after epicardial cryoablation in 1 patient. All patients recovered and remained asymptomatic from the coronary injury and arrhythmias during 37+/-53 months of follow-up.
Coronary arterial injury after ablation procedures is rare. It may present acutely or several weeks after an ablation procedure. Acute occlusion appears to require coronary stenting. Unanticipated anatomic variations can predispose to coronary injury.
目前，关于消融术后冠状动脉损伤的表现及转归仅有一些传闻性信息。
描述了一组连续接受4655例消融手术患者中的4例发生冠状动脉损伤的情况（发生率0.09%）。患者平均年龄为45±11岁，先前平均有1.8±0.5次消融尝试未成功。2例冠状动脉损伤发生于心外膜室性心动过速消融术（1例为灌注射频消融，另1例为冷冻消融），2例发生于心脏中静脉内的灌注射频消融。所有损伤均累及右冠状动脉分支。2例在消融术后立即出现ST段抬高的急性闭塞在术中被识别。闭塞对硝酸甘油或球囊扩张无反应，2例均需置入支架。1例患者在心外膜消融术后2周，因右冠状动脉右心室分支闭塞导致后降支冠状动脉闭塞，发生急性心肌梗死。1例患者在心外膜冷冻消融术后血管造影显示有中度无症状狭窄。在37±53个月的随访期间，所有患者冠状动脉损伤及心律失常恢复良好且无症状。
消融术后冠状动脉损伤罕见。可能在消融术后急性出现或数周后出现。急性闭塞似乎需要冠状动脉支架置入。意外的解剖变异可能易导致冠状动脉损伤。
