A-V NODE ABLATION IN HYPERTROPHIC CARDIOMYOPATHY

肥厚型心肌病(HCM)患者经常有 心律失常和血流动力学异常，并容易猝死 还有晕厥。房颤(房颤)的发生率为15% 肥厚型心肌病(HCM)，可有严重的血流动力学 后果。我们检验了脑室正则化的假说 收缩，但具有对运动的变时性反应 心率响应性室性需求的结部消融和植入 起搏器(VVIR)可改善冠心病患者的症状和血流动力学 药物难治性房颤。连续10例患者(年龄59±13岁；6+2种药物 失败/患者)接受射频(RF)房室结消融加 植入VVIR装置。所有患者都有基线心脏 导尿术。在3.2+1.3个月的随访评估中，症状为 所有患者的情况都有所改善，药物需求也减少了。四 患者接受了重复的导尿术。右心压 3例患者明显减少。此外，对流动的阻碍 两名患者的左心室血液被清除 梗阻性肥厚型心肌病。因此，这些初步发现表明，RF 消融房室结加植入VVIR装置可以是一种 重症肥厚型心肌炎患者的成功治疗策略 有症状，且未能从药物治疗中受益。

Patients with hypertrophic cardiomyopathy (HCM) frequently have arrhythmias and hemodynamic abnormalities, and are prone to sudden death and syncope. Atrial fibrillation (AF) occurs in 15% of patients with hypertrophic cardiomyopathy (HCM) and can have serious hemodynamic consequences. We tested the hypothesis that regularization of ventricular contraction but with provision of chronotropic response to exercise by AV Node ablation and implantation of a rate-responsive ventricular demand pacemaker (VVIR) may improve symptoms and hemodynamics in patients with drug-refractory AF. Ten consecutive patients (age, 59+13 yrs; 6+2 drugs failed/patient) underwent radio-frequency (RF) AV Node ablation plus implantation of a VVIR device. All patients had baseline cardiac catheterization. At 3.2+1.3 months follow-up evaluation, symptoms were improved in all patients and medications requirements were reduced. Four patients have underwent repeat catheterization. Right heart pressures were markedly reduced in 3 patients. In addition, obstruction to flow of blood out of the left ventricle was eliminated in two patients with obstructive HCM. Thus, these preliminary findings suggest that RF ablation of the AV node plus implantation of a VVIR device may be a successful therapeutic strategy in HCM patients who are severely symptomatic and have failed to benefit from drug therapy.