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，并易于猝死 还有晕厥 房颤（AF）发生在15%的患者， 肥厚型心肌病（HCM），并可能有严重的血流动力学 后果 我们检验了心室肌的规则化 收缩，但由AV提供对运动的变时性反应 房室结消融和植入频率响应性心室需求 起搏器（VVIR）可改善患者的症状和血流动力学， 10名连续患者（年龄，59 ± 13岁; 6 ± 2种药物 失败/患者）接受射频（RF）房室结消融术， VVIR装置的植入。 所有患者的基线心脏 漂浮导管在3.2+1.3个月的随访评价中，症状为 所有患者均得到改善，药物需求减少。 四 患者接受了重复导管插入术。 右心压力 3例患者明显降低。 此外，阻碍流动 两名患者的左心室血液被清除， 梗阻性肥厚型心肌病 因此，这些初步研究结果表明，RF 房室结消融加VVIR装置植入可能是一种 严重HCM患者的成功治疗策略 症状，并未能从药物治疗中获益。

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.