高齡者反覆胸悶、心臟亂跳動 電燒手術找回健康心！
2022-11-05 記者 蘇旋/報導
奇美醫學中心心臟血管內科主任施志遠(左)、主治醫師李威杰(中)及主治醫師林志憲共同表.（圖/奇美醫學中心提供）
高齡長者常常會出現反复胸悶、心律不整的問題，大多數人都是傾向以藥物治療，近年來，奇美醫學中心致力於心房顫動的介入性治療，心臟血管內科團隊引進了3D立體定位電燒系統及複雜性肺靜脈隔離電燒手術治療，解決病人心臟亂亂跳的問題，改善了生活品質。
心臟血管內科主治醫師李威杰實際執行3D肺靜脈隔離電燒手術時畫面（圖/奇美醫學中心提供）
71歲男性，合併高血壓及糖尿病多年，10年前曾發生缺血性中風，近來反覆出現胸悶及呼吸喘，雖然沒有發現血管阻塞，但有心律不整的情形已10多年，且心律不整病程已進展到持續型心房顫動，活動時常因心跳快速跳動，感覺好像要跳出來，也曾就醫治療，不過藥物治療效果不佳，因此不太敢運動，對生活造成極大困擾，更擔心再次中風。
經奇美醫學中心心臟血管內科主治醫師李威杰一系列檢查評估後，病人雖然心臟輸出功率正常，但是左右心房已經擴大，連續性心電圖也有病竇症候群的情形，雖藥物調整及積極控制，仍無法改善其症狀及相關不舒服情形，經過醫病共享決策及心臟電腦斷層和經食道超音波相關手術前評估，病人接受心房顫動的「3D肺靜脈隔離電燒手術」，成功的矯正成正常心律，心臟終於不再亂亂跳，也減低藥量，目前情況穩定，定期回門診追蹤，且能增加行走距離及運動時間，明顯改善生活品質。
主講者心臟血管內科主治醫師李威杰及其講題（圖/奇美醫學中心提供）
奇美醫學中心心臟血管內科主治醫師李威杰指出，過去心房顫動病人，可能只有藥物或是體外電擊的方式可以來矯正心律，效果有限且無法持續，約五成以上病人會再復發，有些病人因此進入心臟電氣及構造的持續變形而進入最終的心臟衰竭狀態，甚至已經中風才開始治療。
近年來，國內民眾對於心律不整的認知提升，且越來越重視健康及生活品質的追求，電燒技術及相關醫材也不斷精進，目前使用的電燒導管可使用高功率短時間的模式來進行電燒，更強調安全性及肺靜脈隔離的有效性，有效縮短手術時間，利用三維(3D)立體模式進行，精準定位導管在心臟中的位置，即時描繪出病人的心臟立體構造，透過術前檢查的影像搭配訊號的判斷，精準確認電燒的部位，且不會增加病人及醫護人員的輻射暴露。針對心房顫動的肺靜脈隔離電燒手術，在心房顫動治療中，歐洲心臟學會治療指引也把電燒手術列為病人選擇或是藥物治療效果不佳時的第一級治療指引建議。
奇美醫學中心致力於心房顫動的介入性治療，3D肺靜脈隔離電燒手術目前治療超過20例，治療成功率100%，所有病人皆減低藥量且改善生活品質。
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