Cardiology Department, Nasser Institute for Research and Treatment, Cairo, Egypt.
Electrophysiology Unit, Cardiology Department, Al-Azhar University, Cairo, Egypt.
Curr Cardiol Rev. 2021;17(6):e051121192738. doi: 10.2174/1573403X17666210408093447.
Radiofrequency catheter ablation is a well-established treatment for several cardiac arrhythmias. Arrhythmias originating from the left side of the heart including ventricular and supraventricular tachycardia and ectopy can be successfully ablated through either transseptal or retrograde aortic approach. Although these techniques have a generally low rate of complications, aortic valve injury is a potential complication of ablation at the left cardiac side that warrants more investigation.
The purpose of this review is to evaluate the incidence of iatrogenic aortic valve regurgitation and explore the potential mechanisms and risk factors that might contribute to aortic valve injury during radiofrequency ablation. Additionally, the course and progression of aortic regurgitation in the reported cases will be described.
Authors searched PubMed for articles using the keywords "ablation" AND "aortic insufficiency" OR "aortic valve injury" OR "aortic regurgitation". Case reports and series as well as retrospective and prospective studies were included, and relevant review articles and editorial comments were used as a supplementary source of data. A total of 19 references were used and a detailed description of patient characteristics, procedural techniques, and incidence, predictors, and fate of aortic regurgitation were reported by 11 clinical studies.
There is a small risk of significant iatrogenic aortic regurgitation after radiofrequency ablation of left-sided cardiac arrhythmias, especially techniques performed via a retrograde aortic approach.
Although the risk is not confined to procedures applying direct energy to the aortic cusp region, a more aggressive ablation applied in the vicinity of the valvular complex seems to be associated with a higher risk. Routine post-procedural surveillance should be adopted to detect de novo aortic valve injury following radiofrequency ablation techniques.
射频导管消融术是治疗多种心律失常的成熟方法。起源于心脏左侧的心律失常，包括室性和室上性心动过速和异位节律，可以通过经间隔或逆行主动脉途径成功消融。虽然这些技术的并发症发生率通常较低，但心脏左侧消融的潜在并发症之一是主动脉瓣损伤，需要进一步研究。
本综述的目的是评估医源性主动脉瓣反流的发生率，并探讨可能导致射频消融过程中主动脉瓣损伤的潜在机制和危险因素。此外，还将描述报道病例中主动脉瓣关闭不全的病程和进展。
作者使用“ablation”和“aortic insufficiency”或“aortic valve injury”或“aortic regurgitation”作为关键词在 PubMed 上搜索文章。纳入病例报告和系列研究以及回顾性和前瞻性研究，并将相关综述文章和社论评论作为数据的补充来源。共使用了 19 篇参考文献，11 项临床研究详细描述了患者特征、手术技术以及主动脉瓣关闭不全的发生率、预测因素和转归。
心脏左侧心律失常的射频消融后存在发生明显医源性主动脉瓣关闭不全的风险，尤其是采用逆行主动脉途径的技术。
虽然这种风险不限于将直接能量应用于主动脉瓣区域的手术，但在瓣膜复合体附近进行更激进的消融似乎与更高的风险相关。应采用常规的术后监测来检测射频消融技术后新发的主动脉瓣损伤。
