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希氏束旁室性早搏长时间局灶性冷冻消融术后的房室传导阻滞

Atrioventricular block following prolonged focal cryoablation for parahisian premature ventricular complexes.

作者信息

Lázaro Rivera Carla, Marco Del Castillo Álvaro, Rodríguez Muñoz Daniel

机构信息

Hospital Fundación Jiménez Díaz, Spain.

Hospital Universitario 12 de Octubre, Madrid, Spain.

出版信息

Indian Pacing Electrophysiol J. 2022 Nov-Dec;22(6):286-290. doi: 10.1016/j.ipej.2022.08.001. Epub 2022 Aug 19.

DOI:10.1016/j.ipej.2022.08.001
PMID:35988904
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9649335/
Abstract

A 54-year-old woman with symptomatic premature ventricular contractions (PVC) was referred for electrophysiological study. The earliest activation was located at the parahisian area, so it was decided to ablate using cryoenergy. No AV conduction impairment was observed during cryomapping. PVCs were abolished after the first 15 seconds of cryoablation, without recurrence. However, after 354 seconds of cryoablation, a mild PR prolongation was followed by first degree and 2-to-1 AV block. Termination of cryoablation led to complete recovery without definitive damage and with elimination of the PVC. This case illustrates how lesion formation using cryoenergy can continue to evolve even after several minutes, highlighting the need of monitoring throughout the whole target duration.

摘要

一名患有症状性室性早搏（PVC）的54岁女性被转诊进行电生理研究。最早的激动位于希氏束旁区域，因此决定使用冷冻能量进行消融。冷冻标测期间未观察到房室传导障碍。冷冻消融开始15秒后室性早搏消失，未再复发。然而，冷冻消融354秒后，出现轻度PR间期延长，随后出现一度和2∶1房室传导阻滞。停止冷冻消融后完全恢复，无永久性损伤，室性早搏消失。该病例说明即使在数分钟后，使用冷冻能量形成的损伤仍可能继续演变，强调了在整个目标持续时间内进行监测的必要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d018/9649335/ce49572cf2ff/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d018/9649335/8de1d8567ce9/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d018/9649335/c3109f5b0149/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d018/9649335/c35930a7365a/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d018/9649335/d2b0a53fbf27/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d018/9649335/ce49572cf2ff/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d018/9649335/8de1d8567ce9/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d018/9649335/c3109f5b0149/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d018/9649335/c35930a7365a/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d018/9649335/d2b0a53fbf27/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d018/9649335/ce49572cf2ff/gr5.jpg

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本文引用的文献

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Phrenic Nerve Injury During Cryoballoon-Based Pulmonary Vein Isolation: Results of the Worldwide YETI Registry.冷冻球囊导管肺静脉隔离术中膈神经损伤：全球 YETI 注册研究结果。
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Safety and outcomes of cryoablation for ventricular tachyarrhythmias: results from a multicenter experience.
冷冻消融治疗室性心动过速的安全性和结果：多中心经验。
Heart Rhythm. 2011 Jul;8(7):968-74. doi: 10.1016/j.hrthm.2011.02.038. Epub 2011 Mar 3.
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Cryoablation time-dependent dose-response effect at minimal temperatures (-80 degrees C): an experimental study.Cryoablation 时间依赖性剂量反应效应在最低温度（-80°C）下：一项实验研究。
Europace. 2009 Nov;11(11):1538-45. doi: 10.1093/europace/eup310. Epub 2009 Oct 20.
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The esophageal effects of cryoenergy during cryoablation for atrial fibrillation.冷冻消融治疗心房颤动时冷冻能量对食管的影响。
Heart Rhythm. 2009 Jul;6(7):962-9. doi: 10.1016/j.hrthm.2009.03.051. Epub 2009 Mar 31.
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Cryoablation outcomes for AV nodal reentrant tachycardia comparing 4-mm versus 6-mm electrode-tip catheters.比较4毫米与6毫米电极尖端导管用于房室结折返性心动过速的冷冻消融结果。
Heart Rhythm. 2008 Feb;5(2):230-4. doi: 10.1016/j.hrthm.2007.10.013. Epub 2007 Oct 9.
7
Catheter ablation of ventricular arrhythmias originating in the vicinity of the His bundle: significance of mapping the aortic sinus cusp.希氏束附近起源的室性心律失常的导管消融：主动脉窦嵴标测的意义
Heart Rhythm. 2008 Jan;5(1):37-42. doi: 10.1016/j.hrthm.2007.08.032. Epub 2007 Sep 1.
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9
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