心房颤动患者导管消融治疗后左心房结构和功能变化分析  

Left atrial function and structure changes after catheter ablation in patients with atrial fibrillation

作　　者：王效浣[1] 李广平[1] 郭方明[1] 许纲[1] 曹云山[2] 

机构地区：[1]天津医科大学第二医院心脏科,300211 [2]甘肃省人民医院心内科

出　　处：《中国综合临床》2009年第5期485-487,共3页Clinical Medicine of China

摘　　要：目的应用组织多普勒技术分析导管消融术后阵发性心房颤动（房颤）患者左心房结构和功能的变化。方法32例阵发性房颤患者（房颤组）在EnsiteNvaX三维标测系统下，完全肺静脉电解剖隔离，应用超声心动图于手术前和术后24h、1周、1个月测量左心房内径及容积、二尖瓣跨瓣压差，多切面测定二尖瓣环舒张早期和晚期运动峰值速度，取平均值并计算其比值；以同年龄组非心房颤动志愿者32例为对照（对照组）。结果房颤组均达到完全肺静脉隔离，随访1个月无复发；房颤组患者术前左心房内径及容积均大于对照组（P均〈0．01），术后24h左心房容积较术前扩大（P〈0．05），术后1周缩小（P〈0．05），术后1个月与对照组比较，差异无统计学意义（P〉0．05）；二尖瓣环晚期运动峰值速度房颤组术前较对照组减低（P〈0．01），术后24h较术前减低（P〈0．05），1周后增加（P〈0．05或P〈0．01），1个月后与对照组比较差异无统计学意义（P〉0．05）。结论导管消融术是治疗阵发性房颤的有效方法，术后24h左心房有所扩张、收缩功能减低，但1周好转，1个月时接近术前，可能与消融对左心房损伤后修复过程有关，提示术后应重视血栓的风险和手术的损伤。Objective To investigate the left atrium （LA） function and structure changes in the paroxysmal atrial fibrillation （AF） patients after catheter ablation using tissue Doppler imaging. Methods After complete pulmonary vein, radiofrequency ablation guided by Ensite NavX System, LA systolic function and LA diameter, volume, mean mitral gradient and mitral annulus early and advanced diastolic peak velocity were assessed in 32 cases of paroxysmal AF patients,which were compared with age-matched controls before and after 24 hours, 1 week, 1 month） AF ablation. Results AF did not occur again in 32 AF paroxysmal patients after isolation. LA diameter and volume in AF groups before ablation were larger than controls（P 〈0.01 ） ,which were also larger 24 hours after ablation than before （ P 〉 0.05 ）, but LA volume was larger than before （ P 〈 0.05 ）, and decreased in lweek after ablation （ P 〈 0.05 ）, but had no significant difference compared with controls in 1 month （ P 〉 0.05 ） ; mitral annulus advanced diastolic peak velocity decreased in AF groups before ablation （ P 〈 0.01 ） and was lower than that 24 hours after catheter ablation （P 〈 0.05 ）, but increased after 1 week （ P 〈 0.05 or P 〈 0.01 ）, and had no significance after 1 month. Conclusion Catheter ablation is the effective way to manage AF because LA is distended and atrial systolic function is reduced within 24 hours after procedure, then gradually increased in a week and will nearly recover to that before procedure in a month, which may be correlated with LA repair, implicating that postprocedural thromboembolic risk and procedure injury should be taken into consideration.

关 键 词：心房颤动 射频消融术 左心房结构 

分 类 号：R541.75[医药卫生—心血管疾病] R541.71[医药卫生—内科学]