房颤合并肥厚型梗阻性心肌病心腔内超声指导下行肺静脉隔离附加室间隔消融一例

Catheter Ablation with CARTO Sound Technology of Atrial Fibrillation in Patients with Hypertrophic Cardiomyopathy: A Case Report

摘要: 肥厚型梗阻性心肌病(HOCM)患者合并心房颤动的发生率为一般人群的4~6倍，特别是HOCM合并永久性房颤的患者预后较差，而维持窦性心律可能会对预后有一定程度的改善。目前，对于症状性房颤患者的治疗主要推荐射频消融术。研究表明，房颤消融术后可明显改善患者心衰住院率以及生活质量。HOCM并房颤患者可出现进行性心衰加重、卒中等风险。目前，室间隔射频消融术在心腔内超声指导下能准确定位室间隔，结合心内电解剖标测，从而实现安全、有效的消融，为HOCM患者提供了更为安全、有效的替代治疗方案。本例患者HOCM合并房颤，选择心腔内超声指导下室间隔 + 房颤射频消融术治疗优势突出，即可安全、有效地解决左室流出道梗阻，又可治疗房颤维持窦性心律。

Abstract: The incidence of atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy (HOCM) is 4 - 6 times higher than that in the general population. Especially in patients with permanent atrial fibrillation and HOCM, the prognosis is poor. Maintaining sinus rhythm may improve the prognosis to some extent. At present, radiofrequency ablation is recommended for symptomatic atrial fibrillation. Studies have shown that AF ablation can significantly improve the hospitalization rate and quality of life of patients with heart failure. Patients with HOCM and atrial fibrillation may have the risk of progressive heart failure and stroke. At present, the ventricular septum radiofrequency ablation can accurately locate the ventricular septum under the guidance of intracardiac echocardiography, combined with intracardiac electroanatomic mapping, so as to achieve safe and effective ablation, and provide a much safer and effective alternative treatment for patients with HOCM. This case of HOCM complicated with atrial fibrillation was treated by intracardiac ultrasound-guided ventricular septum + atrial fibrillation radiofrequency ablation, which can solve the obstruction of left ventricular outflow tract safely and effectively, treat atrial fibrillation and maintain sinus rhythm.