房颤导管消融后膈神经损伤的特征及结局:一项多中心研究

作     者：Sacher F. Monahan K.H. Thomas S.P. 马超 

作者机构：Hpital Cardiologique du Haut-Lévêque UniversitéBordeaux II Bordeaux-Pessac France Dr. 

出 版 物：《世界核心医学期刊文摘（心脏病学分册）》 (Digest of the World Core Medical Journals(Cardiology))

年 卷 期：2006年第2卷第11期

页      面：52-52页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：导管消融 膈神经 电隔离 左心耳 上腔静脉 呼吸困难 呼吸状况 持久性 临床症状 

摘      要：Objectives: The purpose of this study was to characterize the occurrence of phrenic nerve injury(PNI) and its outcome after radiofrequency(RF) ablation of atrial fibrillation(AF). Background: It is recognized that extra-myocardial damage may develop owing to penetration of ablative energy. Methods: Between 1997 and 2004, 3,755 consecutive patients underwent AF ablation at five centers. Among them, 18 patients(0.48%; 9 male, 54±10 years) had PNI(16 right, 2 left). The procedure consisted of pulmonary vein(PV) isolation in 15 patients and anatomic circumferential ablation in 3 patients, with additional left atrial lesions(n=11) and/or superior vena cava(SVC) disconnection(n=4). Results: Right PNI occurred during ablation of right superior PV(n=12) or SVC disconnection(n=3). Left PNI occurred during ablation at the left atrial appendage. Immediate features were dyspnea, cough, hiccup, and/or sudden diaphragmatic elevation in 9, and in the remaining the diagnosis was made after ablation owing to dyspnea(n=7) or on routine radiographic evaluation(n=2). Four patients(22%) were asymptomatic. Complete recovery occurred in 12 patients(66%). Recovery occurred within 24 h in the two patients with left PNI and in one patient with right PNI occurring with SVC disconnection. In the other nine patients, right PNI recovery occurred after 4±5 months(1 to 12 months) with respiratory rehabilitation. After a mean follow-up of 36±33 months, six patients have persistent PNI(three with partial and three with no recovery). Conclusions: In this multicenter experience, PNI was a rare complication(0.48%) of AF ablation. Ablation of the right superior PV, SVC, and left atrial appendage were associated with PNI. Complete(66%) or partial(17%) recovery was observed in the majority.