射频消融与药物治疗阵发性房颤复律后心房电机械功能的对比研究  

Comparison of the atrial electro-mechanical function after successful cardioversion as a result of radiofrequency ablation and drug therapy for paroxysmal atrial fibrillation

作　　者：成少永 张晓婷[1] 徐雪纯 李利[2] 孔冬梅[3] 郭元芳[1] 端木鲁健 郑军[5] 黄丛春[6] 王建昌[6] 王俊华[6] 

机构地区：[1]河北北方学院研究生部,河北张家口075000 [2]解放军空军总医院超声科,北京100142 [3]解放军空军总医院特诊科,北京100142 [4]山东鄄城县人民医院心血管内科,山东鄄城274600 [5]解放军空军总医院全军临床航空医学中心,北京100142 [6]解放军空军总医院心血管内科,北京100142

出　　处：《解放军医学杂志》2015年第5期387-391,共5页Medical Journal of Chinese People's Liberation Army

基　　金：全军"十二五"医学科研面上项目(CWS11J188);全军"十二五"医学科研重大项目(AKJ11J004);全军"十二五"医学科研重点课题(BWS11J054)~~

摘　　要：目的对比射频消融术与药物治疗阵发性房颤(PAF)成功前后心房电机械功能的变化。方法选取2011年1月-2014年6月在空军总医院住院的PAF患者60例及健康体检的窦律患者20例,实验分3组:对照组(n=20)、射频消融组(n=30)、药物治疗组(n=30)。所有受试者均进行心电图和超声心动图检查,治疗后随访时复查上述检查。对比治疗前3组的P波时限、振幅,心房容积及应变率等指标及两组PAF患者治疗后的上述参数。结果治疗前射频消融组和药物治疗组的PAF患者间P波时限、振幅,心房容积和应变率等心房参数比较差异无统计学意义(P>0.05),但均显著低于对照组(P<0.05);治疗后3个月两组患者的心房参数均出现好转,应变率等机械参数明显改善(P<0.05);6个月时心房参数进一步好转,且射频消融组各参数改善明显优于药物治疗组(P<0.05)。讨论P波时限、振幅,心房容积及应变率可以较好地评价心房电机械功能,射频消融和药物治疗后PAF患者的心房传导、机械运动功能均得到改善,且射频消融组在疗效和心房参数改善上均优于药物治疗组。机械运动功能改善早于电传导功能,可作为评价PAF患者复律后心房功能改善的敏感指标。Objective To compare the change in atrial electro-mechanical function after successful cardioversion treated by radiofrequency ablation or antiarrhythmic drug therapy in paroxysmal atrial fibrillation（PAF）. Methods Sixty patients with PAF and 20 patients with sinus rhythm（control group）, admitted or receiving physical examination at the Air Force General Hospital from Jan. 2011 to Jul. 2014, were consecutively enrolled in the present study. Thirty PAF patients were assigned to either the ablation group or drug treatment group according to their own intention. All the subjects received the baseline electrocardiogram and echocardiography, and the same examinations were repeated in all PAF patients in follow up period. P wave duration and amplitude, atrial volume and strain rate were analyzed, and these parameters were compared between the two treatment groups at follow-up. Results No significant difference was detected in baseline parameters of the P wave duration and amplitude, atrial volume, and the strain rate between two PAF groups（P〉0.05）. However, these parameters were significantly lower than those in control group（P〈0.05）. Three months after treatment, these atrial parameters were found to be improved, and atrial mechanical parameters including the strain rate was improved obviously（P〈0.05）. At six-month follow up, atrial parameters of the two PAF groups were further improved. Compared with patients of drug treatment group, the results in patients of ablation group were significantly better（P〈0.05）. Conclusions The P wave duration and amplitude, atrial volume and strain rate can be used as suitable parameters to evaluate the atrial electro-mechanical function. The atrial conduction and mechanical function of PAF patients can be improved by radiofrequency ablation or by drug therapy. Compared with drug therapy, ablation is more effective in improving the atrial parameters. The improvement of mechanical parameters is earlier than that of electrical conductivity, and it can be u

关 键 词：心房颤动 导管消融术 心房电机械功能 

分 类 号：R541.75[医药卫生—心血管疾病]