射频消融并植入心脏起搏器对房颤患者生活质量及心功能的影响  

Effects of catheter ablation and pacemaker implantation on quality of life and ventricular function in patients with atrial fibrillation

作　　者：曲志刚[1] 廖德宁[2] 牛晓萍[2] 姜洪[1] 

机构地区：[1]南京军区福州总医院侨宾科,福建福州350025 [2]上海市长征医院心血管内科

出　　处：《心血管康复医学杂志》2010年第1期72-75,共4页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的:研究射频消融阻断房室传导同时植入永久性人工心脏起搏器对老年心房颤动(房颤)患者生活质量及心室结构和功能的影响。方法:2005年1月至2007年2月,7例老年房颤患者在长征医院接受射频消融阻断房室传导同时植入永久性人工心脏起搏器。术前及术后随访平均(7.7±4.9)月时进行生活质量问卷调查及心脏超声检查。结果:患者术后心悸、气短、头晕、胸痛评分较术前显著增加,分别提高120%、104%、94%和25%(P均<0.01);总生活质量评分显著改善(P<0.01)。与术前相比,7例患者术后室间隔舒张末期厚度(IVSTd)[(11.6±2.3)mm∶(9.1±1.4)mm]、室间隔收缩末期厚度(IVSTs)[(17.1±5.1)mm∶(11.8±1.2)mm]、左心室后壁舒张末期厚度(LVPWTd)[(11.0±2.1)mm∶(9.1±1.4)mm]、左心室后壁收缩末期厚度(LVPWTs)[(16.3±1.9)mm∶(12.2±0.8)mm]显著减小(P均<0.05)。3例植入房室全能型起搏器(DDD)的患者,术前后左室射血分无明显变化。心室按需型起搏器。6名患者术后左室收缩末期内径(LVEDs)较术前显著增大[(30.0±6.4)mm∶(34.0±6.4)mm,P=0.01]。无起搏失灵、起搏电极脱位、囊袋感染及起搏综合征等并发症。结论:对于症状严重、药物疗效差或不能耐受药物治疗的老年心房颤动患者,射频消融阻断房室传导同时植入永久性人工心脏起搏器能显著减轻症状,提高生活质量。Objective：To assess the effects of catheter ablation of the AV conduction system and permanent pacemaker implantation on quality of life and cardiac structure and function in patients with drug-refractory symptomatic atrial fibrillation（AF）.Methods：Inpatients referred for catheter ablation of the AV conduction system and permanent pacemaker implantation due to medically-refractory atrial fibrillation in the cardiovascular department of Changzheng hospital were screened for enrollment in a prospective registry.Baseline assessment prior to ablation included measurement of symptoms and quality of life with Karolinska questionnaire（KQ） and cardiac structure and function quantitated with echocardiography.The quality of life measurement and echocardiography were repeated at follow-up after catheter ablation.Results：Complete AV block was achieved in all seven AF patients.No procedure-related complications occurred during follow-Up.Arrhythmia-related symptoms such as palpitations,dyspnea,dizziness and chest discomfort were markedly improved （120%,104%,94%,25% respectively）as measured with KQ,quality of life also increased 66%.In（7.7±4.9） months of follow-up,echocardiographic measurement revealed a significant reduction of IVSTd[（11.6±2.3）mm vs.（9.1±1.4）mm] IVSTs[（17.1±5.1）mm vs.（11.8±1.2）mm],LVPWTd[（11.0±2.1）mm vs.（9.1±1.4）mm] and LVPWTs[（16.3±1.9）mm vs.（12.2±0.8）mm],P〈0.05 all.The LVEF in three patients receiving DDD pacemaker was not statistically different.LVEDs was significantly increased[（30.0±6.4）mm vs.（34.0±6.4）mm,P〈0.01] in 6 patients.Conclusion：Catheter ablation of atrioventricular junction and permanent pacemaker implantation are associated with improved quality of life in geriatric highly symptomatic patients with atrial fibrillation refractory to medical therapy.

关 键 词：心房颤动 导管消融 心脏起搏器 人工 

分 类 号：R541.75[医药卫生—心血管疾病]