Anguera I, Brugada J, Brugada P, Mont L, Valentino M, Aguinaga L, Matas M, Navarro-López F
Instituto de Enfermedades Cardiovasculares, Hospital Clínic i Universidad de Barcelona.
Rev Esp Cardiol. 1998 Apr;51(4):307-13. doi: 10.1016/s0300-8932(98)74750-5.
Radiofrequency ablation of the atrioventricular conduction system has become an established therapy for patients with drug-refractory atrial fibrillation. We observed 14 patients with hemodynamic deterioration related to worsening of mitral regurgitation after the procedure.
We retrospectively evaluated 256 consecutive patients with drug-refractory atrial fibrillation referred for radiofrequency ablation of the AV node and implantation of a pacemaker. Because we found hemodynamic deterioration related to worsening mitral regurgitation, we compared the clinical history, electrophysiologic and echocardiographic data from the patients with hemodynamic deterioration and worsening mitral regurgitation (group A) with those without hemodynamic deterioration (group B).
Fourteen out of 256 patients (group A) undergoing ablation of the atrioventricular conduction system deteriorated with acute pulmonary edema (3 patients) or congestive heart failure (11 patients) at a mean of 6 weeks after the ablation procedure. Four of these patients were referred for mitral valve surgery. The length of the procedure and the number of applications during ablation were similar in both groups. Compared with group B patients, group A patients had significantly higher left ventricular end-diastolic diameters (64 +/- 6 mm vs 56 +/- 9 mm; p < 0.05) at baseline despite similar left ventricular end-systolic diameters, fractional shortening and grade of mitral regurgitation (1.15 +/- 1.05 vs 1.11 +/- 0.97). Moreover, whereas no change was observed in left ventricular end-diastolic diameter, left ventricular end-systolic diameter, fractional shortening and grade of mitral regurgitation in group B patients after ablation, group A patients experienced a significant increase in left ventricular end-diastolic diameter (64 +/- 6 mm vs 72 +/- 9 mm; p < 0.01) and grade of mitral regurgitation (1.15 +/- 1.05 vs 2.90 +/- 1.15; p < 0.01). In patients operated on no ablation related structural damage to the mitral valve apparatus could be detected. The worsening of the mitral regurgitation was related to dilation of the mitral valve annulus.
Hemodynamic deterioration together with progression of mitral regurgitation is a potential complication of ablation of the atrioventricular conduction system.
房室传导系统的射频消融已成为药物难治性心房颤动患者的一种既定治疗方法。我们观察到14例患者在该手术后因二尖瓣反流恶化出现血流动力学恶化。
我们回顾性评估了256例连续的药物难治性心房颤动患者，这些患者因房室结射频消融和起搏器植入前来就诊。由于我们发现了与二尖瓣反流恶化相关的血流动力学恶化情况，我们将出现血流动力学恶化和二尖瓣反流恶化患者（A组）的临床病史、电生理和超声心动图数据与未出现血流动力学恶化的患者（B组）进行了比较。
256例接受房室传导系统消融的患者中有14例（A组）在消融术后平均6周出现急性肺水肿（3例）或充血性心力衰竭（11例）而病情恶化。其中4例患者接受了二尖瓣手术。两组手术时间和消融过程中的应用次数相似。与B组患者相比，A组患者在基线时尽管左心室收缩末期直径、缩短分数和二尖瓣反流分级相似，但左心室舒张末期直径显著更大（64±6mm对56±9mm；p<0.05）（1.15±1.05对1.11±0.97）。此外，B组患者消融后左心室舒张末期直径、左心室收缩末期直径、缩短分数和二尖瓣反流分级均未观察到变化，而A组患者左心室舒张末期直径（64±6mm对72±9mm；p<0.01）和二尖瓣反流分级（1.15±1.05对2.90±1.15；p<0.01）显著增加。在接受手术的患者中，未检测到与消融相关的二尖瓣装置结构损伤。二尖瓣反流的恶化与二尖瓣环扩张有关。
血流动力学恶化以及二尖瓣反流进展是房室传导系统消融的一种潜在并发症。
