经导管环肺静脉左房线性消融术对阵发性心房颤动患者左心房结构和功能的影响  

Evaluation of left atrial structure and function serial changes after circumferential pulmonary vein ablation for paroxysmal atrial fibrillation

作　　者：徐瑾[1] 陈颖敏[1] 李宏松[1] 李洪波[1] 应小盈[1] 宋秀兰[1] 何奔[1] 

机构地区：[1]上海交通大学医学院附属仁济医院心内科,上海200001

出　　处：《心脏杂志》2011年第1期91-94,共4页Chinese Heart Journal

摘　　要：目的:评价环肺静脉左房线性消融术对阵发性心房颤动(房颤)患者左心房结构和功能的影响。方法:阵发性房颤患者33例,Carto系统下行环肺静脉左房线性消融术,应用超声心动图测定其消融术前1～3 d、术后1、3、6、12个月静息时窦性心律下左心房内径、容积指标、二尖瓣口A波速度峰值(VA)及E波速度峰值(VE),并计算左心房排空分数,分析消融术前后左心房结构和功能的变化。结果:33例阵发性房颤患者均成功施行环肺静脉左房线性消融术,1年治愈率82%。左房前后径消融术后1个月较术前显著增大[(44±4)mm vs.(41±3)mm,P<0.01],术后3个月、6个月时与术前比较无显著差异,随访1年时左房前后径较术前有显著减小[(40±3)mm vs.(41±3)mm,P<0.05]。与左心房辅助泵功能相关的左心房最小容积,术后1个月显著增大,左心房主动排空分数、左心房总排空分数显著降低(P<0.05),术后3个月时恢复到术前水平。VA术后均低于术前(P<0.05,P<0.01),而VE/VA术后1个月显著上升(P<0.05,P<0.01),但在随后的随访中与术前无显著差异。结论:阵发性房颤患者左房环肺静脉线性消融术后近期左房前后径增大,辅助泵功能下降,术后3个月恢复至术前水平,术后1年左房结构可部分逆重构。AIM： To evaluate the left atrial structure and function serial changes after circumferential pulmonary vein ablation（CPVA） for paroxysmal atrial fibrillation.METHODS： Thirty-three patients with paroxysmal atrial fibrillation underwent CPVA guided by CARTO.Conventional echocardiography was performed 1-3 days before CPVA and 1,3,6 and 12 months after CPVA.Echocardiographic parameters including left atrial（LA） diameter,volume indicators,mitral peak A wave velocity（VA） and peak E-wave velocity（VE） were measured at rest during sinus rhythm.left atrial emptying fractions were calculated to analyze the left atrial structure and function serial changes before and after CPVA.RESULTS： CPVA was successfully performed in all 32 patients with paroxysmal atrial fibrillation and the 1-year cure rate was 82%.Compared with that 1-3 days pre-CPVA,LA diameter significantly increased [（44±4） mm vs.（41±3） mm,P〈0.01] 1 month after CPVA and no significant differences were seen 3 months and 6 months after CPVA.One-year follow-up showed that LA diameter significantly decreased [（40±3） mm vs.（41±3） mm,P〈0.05] compared with that pre-CPVA.Compared with that 1-3 days pre-CPVA,LA minimum volume significantly increased（P〈0.05） and the indicators of LA pump function such as LA active emptying fraction and LA total emptying fraction significantly decreased（P〈0.05） 1 month after CPVA.Three months after CPVA,these parameters returned to the pre-CPVA levels.VA after CPVA was lower than that pre-CPVA（P〈0.05,P〈0.01）,whereas VE/VA 1 month after CPVA increased significantly（P〈0.05,P〈0.01） but VE/VA in the subsequent follow-up returned to the pre-CPVA level.CONCLUSION： CPVA for paroxysmal atrial fibrillation has some negative effects on recent LA structure and mechanical function with the increase in LA diameter and the decline in LA pump function.But these negative effects are relatively mild and reversible and will restore 3 months after CPVA.Long-term follow-up has demonstrat

关 键 词：心房颤动 射频导管消融 心房功能 超声心动描记术 

分 类 号：R541.7[医药卫生—心血管疾病]