2019 年第 4 期 第 14 卷

冠状动脉旁路移植术中实施双极射频消融术对心肌梗死后室壁瘤相关室性心律失常患者预后的影响

Effect of bipolar radiofrequency ablation during coronary artery bypass grafting on prognosis of ventricular arrhythmia associated with ventricular aneurysm after myocardial infarction

作者：王鹏程祁丹妮高铭鑫于文渊唐田胡晖于洋

英文作者：

单位：100029首都医科大学附属北京安贞医院心外重症医学科（王鹏程），心脏外科（高铭鑫、于文渊、唐田、胡晖、于洋）；100084北京，清华大学临床医学院综合办公室（祁丹妮）

英文单位：

关键词：心肌梗死；室性心律失常；双极射频消融术；冠状动脉旁路移植术

英文关键词：

• 摘要：

• 【摘要】目的    探讨心肌梗死后室壁瘤相关室性心律失常患者于冠状动脉旁路移植术中实施双极射频消融术的预后。方法    选择2015年1月至2017年12月首都医科大学附属北京安贞医院收治的心肌梗死后室壁瘤相关室性心律失常患者75例，24 h动态心电图提示频发室性期前收缩＞100次/h。所有患者均接受气管插管全身麻醉下双极射频消融术联合冠状动脉旁路移植术治疗，术中监测生命体征，术后住院恢复期间复查24 h动态心电图和超声心动图。结果    全组无一例手术死亡。75例患者中二次开胸止血1例（1.3%），术后伤口感染2例（2.7%），术后脑梗死1例（1.3%），术后室上性心动过速11例（14.7%）。平均搭桥血管（3.6±0.8）支，平均住院时间（15±4）d，出院前复查超声心动图提示左心室射血分数与术前比较无明显改善［(48±4)%比（48±6）%］（t=1.293，P=0.200），复查24 h动态心电图提示24 h室性期前收缩数量较术前明显减少［(2 931±1 315)次比（4 905±1 855）次］（t=7.522，P=0.014）。结论    冠状动脉旁路移植术中应用双极射频消融术可有效解决心肌缺血与瘢痕折返所致室性心律失常，改善患者围术期预后。

• 【Abstract】Objective    To observe whether bipolar radiofrequency ablation during coronary artery bypass grafting can improve the prognosis of patients with ventricular aneurysm-related ventricular arrhythmia after myocardial infarction. Methods    A total of 75  patients with ventricular aneurysm-related ventricular arrhythmia after myocardial infarction were enrolled in Beijing Anzhen Hospital, Capital Medical University between January 2015 and December 2017. Twenty-four hours ambulatory electrocardiogram suggested frequent ventricular premature contraction＞100 times/h. All patients accepted bipolar radiofrequency ablation combined with coronary artery bypass grafting under general anesthesia with endotracheal intubation. Vital signs were monitored during operation. Twenty-four hours ambulatory electrocardiogram and echocardiogram were reexamined during in-hospital recovery after surgery. Results    There was no death during operation. There was 1 case（1.3%）of secondary thoracotomy due to hemorrhage, 2 cases（2.7%）of wound infection, 1 case（1.3%） of cerebral infarction and 11 cases（14.7%） of supraventricular tachycardia after surgery. Average number of bypass vessels was (3.6±0.8) and average stay was (15±4）d. Before discharge, echocardiography showed that there  was no significant improvement of left ventricular ejection fraction compared to that before surgery［(48±4)% vs （48±6）%］（t=1.293, P=0.200）; ambulatory electrocardiogram showed that the number of 24 h premature ventricular contraction significantly decreased than that before surgery［（2 931±1 315）beats vs （4 905±1 855）beats］（t=7.522, P=0.014）. Conclusion    Bipolar radiofrequency ablation during coronary artery bypass grafting can effectively improve the perioperative prognosis of patients with ventricular arrhythmia caused by myocardial ischemia and scar reentry.