超声技术评价不同的消融术式对阵发性心房颤动患者左心房功能的长期影响  

Assessment of left atrial function using echocardiography in patients with paroxysmal atrial fibrillation after different strategy of radiofrequency catheter ablation

作　　者：朱彩霞[1] 李莹[1] 张代富[1] 陈明[2] 刘怡[2] 郑建华[2] 祁伟罡[1] 顾宇英[1] 梁波[1] 俞莉[1] 包丽娟[1] 

机构地区：[1]同济大学附属东方医院心内科,上海200120 [2]同济大学附属东方医院心功能室

出　　处：《临床心血管病杂志》2007年第1期45-48,共4页Journal of Clinical Cardiology

基　　金：上海市浦东新区社会发展局(No:PW2006A-3)

摘　　要：目的：探讨不同的射频消融术式对阵发性心房颤动（PAf）患者左房功能的远期效应。方法：PAf患者65例，接受节段性肺静脉隔离术（SPVI）27例和左房线性消融术（CPVA）38例，术后平均随访6～27（14．9±5．5）个月，应用超声心动图观察消融成功者手术前、后左房功能的变化，采用M型和二维超声测量左房内径，多普勒测量二尖瓣血流频谱，组织多普勒测量二尖瓣环舒张晚期运动速度（Va）。结果：①SPVI组的27例患者中18例消融成功（66．7％），CPVA组的38例患者中28例消融成功（73．7％）；②2组中消融成功者术前左房大小相似，术后长期维持窦性心律时左房内径减小（P〈0．05）；③消融成功者左房收缩功能好转，心房收缩期A波峰速度和积分都较术前升高（P〈0．05），SPVI组的左房充盈分数比术前增加（P〈0．05），CPVA组内左房射血力和左房充盈分数与术前比较差异无统计学意义；2组间比较血流频谱指标无差异，SPVI组Va高于CPVA组。结论：射频消融术是治疗PAf的有效方法，长期随访显示消融成功者左房结构和收缩功能好转，但CPVA可能对左房局部收缩功能有影响。Objective..To evaluate the effects of different strategy of radiofrequency ablation on left atrial （LA） function in patients with paroxysmal atrial fibrillation （PAf） after long-term follow-up. Method：Sixty-five consecutive patients with PAf were treated by segmental pulmonary vein isolation （SPVI） or circumferential radiofrequency pulmonary vein ablation （CPVA） （n = 27,38, respectively）. The mean follow-up duration was （ 14.9±5. 5） months （range,6 to 27 months）. To evaluate the change of LA function in patients successfully ablated after long-term follow-up, we examined the LA diamentions by M-mode and 2-dimensional echocardiography, mitral inflow by Doppler echocardiography before and after ablation. And we measured the velocity of mitral annulus motion （Va） in late diastolic phase by tissue Doppler image after ablation. Result：①Eighteen patients （66.7 %）out of twenty-seven in SPVI group were successfully ablated, and twenty-eight （73.7 %） patients out of thirty-eight in CPVA group. ②The LA size was similar before ablation between the two successfully ablated groups, and decreased after ablation in both successful groups（P〈0. 05）.③The LA systolic function improved in the two groups. VA and A-VTI increased （P〈0.05）. AFF increased only in SPVI group （P〈0. 05） and had no difference in CPVA group. There was no difference between the two ablation strategies in mitral inflow, but Va was lower in CPVA group. Conclusion：Catheter ablation for PAf is effective. The LA diamentions decreased and global systolic function improved after long-term follow-up, although the regional LA systolic function was more impaired by CPVA.

关 键 词：心房颤动 导管消融术 超声心动描记术 心房功能 左 

分 类 号：R541.7[医药卫生—心血管疾病]