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肺静脉隔离期间吸气诱发的左心房负压的患病率及特征

Prevalence and Characteristics of Inspiration-Induced Negative Left Atrial Pressure during Pulmonary Vein Isolation.

作者信息

Ikoma Takenori, Naruse Yoshihisa, Kaneko Yutaro, Sakakibara Tomoaki, Narumi Taro, Sano Makoto, Mogi Satoshi, Suwa Kenichiro, Ohtani Hayato, Saotome Masao, Urushida Tsuyoshi, Maekawa Yuichiro

机构信息

Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi Ward, Hamamatsu 431-3192, Japan.

出版信息

J Cardiovasc Dev Dis. 2023 Feb 26;10(3):101. doi: 10.3390/jcdd10030101.

DOI:10.3390/jcdd10030101
PMID:36975865
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10056480/
Abstract

BACKGROUND

Atrial fibrillation (AF) ablation is performed under deep sedation, which may cause inspiration-induced negative left atrial pressure (INLAP) associated with deep inspiration. INLAP could be the cause of periprocedural complications.

METHODS

We retrospectively enrolled 381 patients with AF (mean age, 63.9 ± 10.8 years; 76 women; 216 cases of paroxysmal AF) who underwent CA under deep sedation using an adaptive servo ventilator (ASV). Patients whose LAP was not obtained were excluded. INLAP was defined as <0 mmHg of mean LAP during inspiration immediately after the transseptal puncture. The primary and secondary endpoints were the presence of INLAP and the incidence of periprocedural complications.

RESULTS

Among 381 patients, INLAP was observed in 133 (34.9%). Patients with INLAP had higher CHADS-Vasc scores (2.3 ± 1.5 vs. 2.1 ± 1.6) and 3% oxygen desaturation indexes (median 18.6 (interquartile range 11.2-31.1) vs. 15.7 (8.1-25.3)), and higher prevalence of diabetes mellitus (23.3 vs. 13.3%) than patients without INLAP. Air embolism occurred in four patients with INLAP (3.0 vs. 0.0%).

CONCLUSION

INLAP is not rare in patients undergoing CA for AF under deep sedation with ASV. Much attention should be paid to the possibility of air embolism in patients with INLAP.

摘要

背景

心房颤动（AF）消融术在深度镇静下进行，这可能会导致与深吸气相关的吸气诱发左心房负压（INLAP）。INLAP可能是围手术期并发症的原因。

方法

我们回顾性纳入了381例AF患者（平均年龄63.9±10.8岁；76例女性；216例阵发性AF），这些患者在深度镇静下使用适应性伺服通气机（ASV）进行导管消融（CA）。未获得左心房压力（LAP）的患者被排除。INLAP定义为经房间隔穿刺后立即吸气时平均LAP<0 mmHg。主要和次要终点分别是INLAP的存在情况和围手术期并发症的发生率。

结果

在381例患者中，133例（34.9%）观察到INLAP。与无INLAP的患者相比，有INLAP的患者CHADS-Vasc评分更高（2.3±1.5对2.1±1.6）、氧饱和度下降指数为3%时更高（中位数18.6（四分位间距11.2 - 31.1）对15.7（8.1 - 25.3）），糖尿病患病率更高（23.3%对13.3%）。4例有INLAP的患者发生了空气栓塞（3.0%对0.0%）。

结论

在使用ASV进行深度镇静的AF患者CA过程中，INLAP并不罕见。应高度重视有INLAP患者发生空气栓塞的可能性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4e66/10056480/bbe55c1b981a/jcdd-10-00101-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4e66/10056480/925983ce8c0b/jcdd-10-00101-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4e66/10056480/5a4f0851a98c/jcdd-10-00101-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4e66/10056480/2323bbc47984/jcdd-10-00101-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4e66/10056480/b010c88c274d/jcdd-10-00101-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4e66/10056480/bbe55c1b981a/jcdd-10-00101-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4e66/10056480/925983ce8c0b/jcdd-10-00101-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4e66/10056480/5a4f0851a98c/jcdd-10-00101-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4e66/10056480/2323bbc47984/jcdd-10-00101-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4e66/10056480/b010c88c274d/jcdd-10-00101-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4e66/10056480/bbe55c1b981a/jcdd-10-00101-g005.jpg

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