Purpose

Delineate retrospectively and prospectively the incidence and characteristics of transient ST-segment elevation during transseptal puncture.

Methods

The study retrospectively evaluated 307 patients from January 1, 2015, to December 31, 2017, and prospectively evaluated 231 patients from January 1, 2018, to July 31, 2019.

Results

The presence of ST-segment elevation was significantly higher in the prospective sample than in the retrospective sample (5.2% vs. 1.3%, p < 0.05). Between the two groups, there was no significant difference in age, sex, comorbidities, left atrial volume index, and the etiology of atrial fibrillation among patients with ST-segment alteration. In all patients, the ST-segment elevation was observed in the inferior wall derivations, except for one patient with ST elevation in lead I, AVL, V1-V4 during the septal puncture, associated with sinus bradycardia and reversed hypotension with intravenous fluids. Comparative analysis of the systolic and diastolic arterial pressure and the minimum heart rate during the phenomenon demonstrated more severity in the retrospectively evaluated population than in the prospective population. There was a significant association between the occurrence of ST-segment elevation > 2 mm and the presence of symptoms. In these patients, coronary angiography showed no alterations. Atropine was administered to one patient who presented with junctional bradycardia after the puncture. This medication reversed the situation.

Conclusion

ST-segment elevation is a short-term phenomenon that can occur during transseptal catheterization without clinically evident symptoms. The catheter ablation procedure can be safely concluded despite the occurrence of the phenomenon.

中文翻译：

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经间隔穿刺时短暂性 St 段抬高的发生率和特征

目的

回顾性和前瞻性地描述经间隔穿刺期间短暂 ST 段抬高的发生率和特征。

方法

该研究回顾性评估了 2015 年 1 月 1 日至 2017 年 12 月 31 日期间的 307 名患者，并前瞻性评估了 2018 年 1 月 1 日至 2019 年 7 月 31 日期间的 231 名患者。

结果

前瞻性样本中 ST 段抬高的存在显着高于回顾性样本（5.2% 对 1.3%，p < 0.05)。两组间ST段改变的患者在年龄、性别、合并症、左心房容积指数、房颤病因等方面均无显着差异。在所有患者中，除 1 例患者在间隔穿刺期间 I、AVL、V1-V4 导联 ST 段抬高外，所有患者均在下壁引出处观察到 ST 段抬高，并伴有窦性心动过缓和静脉输液逆转低血压。对收缩压和舒张压以及该现象期间的最低心率的比较分析表明，回顾性评估的人群比预期人群的严重程度更高。ST 段抬高 > 2 mm 的发生与症状的存在显着相关。在这些患者中，冠状动脉造影未见改变。一名在穿刺后出现交界性心动过缓的患者服用了阿托品。这种药物扭转了局面。

结论

ST 段抬高是一种短期现象，可在经间隔导管插入术期间发生，而无临床明显症状。尽管发生了这种现象，导管消融手术仍可安全结束。