心动过速型心肌病射频消融后的临床观察  

Clinical observation of tachycardia-induced cardiomyopathy after radiofrequency cather ablation

作　　者：张飞飞[1] 彭新辉[1] 杨浩[1] 黄福美 何利伟[1] 赖雯苑 彭健[1] 

机构地区：[1]南方医科大学南方医院心内科,广州市510515

出　　处：《实用医学杂志》2014年第7期1084-1087,共4页The Journal of Practical Medicine

基　　金：广州市科技计划项目(编号:201300000146)

摘　　要：目的:探讨射频消融术(RFCA)治疗心动过速型心肌病(TCM)后左室收缩功能的恢复情况。方法:收集2010年7月至2013年7月在我院因心律失常行消融治疗患者共715例,其中33例左室射血分数(LVEF)<50%,且术后升高≥15%的心动过速型心肌病患者纳入研究。经消融治疗1周后,早期LVEF改善明显的(与基线相比,术后第1周LVEF升高幅度≥25%)设为改善组,无明显变化的则为未改善组。所有患者术后1周、3个月、6个月、12个月均行超声心动图检查。结果:患者基线左室舒张末期内径及LVEF分别为(55±10.7)mm,(38±4.6)%。早期LVEF明显改善者16例,经过12个月的随访,改善组与未改善组相比,保持较高的LVEF[(69.2±4.2)%vs(58.1±6.9)%,P<0.001]。结论:RFCA被证明是一种较为安全而有效的治疗方法;房颤相关的TCM节律控制优于室率控制;术后早期LVEF的改变对患者左室功能的恢复具有预测作用。Objective To determine the baseline echocardiographic characteristics and the time course and degree of recovery of left ventricular （LV） systolic dysfunction in patients with tachycardia-induced cardiomyopathy （TCM）. Methods Seven hundred and fifteen patients received radiofrequency cather ablation （RFCA） for tachycardiarrhymias from July 2010 to July 2013 were screened in this study. Only 33 patients with reduced left ventricular ejection fraction （LVEF）（LVEF〈50% and improved≥ 15%） were diagnosed with tachycardia-induced cardiomyopathy and were included in the study. Patients with early improvement （over 25% increase in LVEF at 1- week follow-up compared to the baseline） were enrolled in the improved group, and the rest patients were enrolled in the improved group. All Patients received transthoracic echocardiography for LV size and function detection at 1 week and at 3,6, 12 months follow-up. Results The average baseline of the LV end-diastolic diameter, and the LVEF were （55 ± 10.7）mm and （38± 4.6）%, repectively. Early improvement （ over 25% increase in LVEF at 1- week follow-up compared to the baseline） in the improved group was observed in 16 patients. Patients with early improvement had higher LVEF at 12-month follow-up compared to the patients without early improvement [ （69.2± 4.2）% vs （58.1±6.9）%, P 〈 0.001]. Conclusions RFCA is proved to be a relatively safe and effecient treatment method. Atrial fibrillation related to TCM, rhythm control is superior to the rate control. The early improvement in LVEF may potentially predict the complete reversibility of LV systolic dysfunction.

关 键 词：心肌疾病 导管射频消融术 左心室收缩功能 超声心动图 

分 类 号：R541.71[医药卫生—心血管疾病]