导管消融治疗心动过速对心动过速型心肌病的疗效  

Clinical efficacy of cather ablation on tachycardia-induced cardiomyopathy

作　　者：陈艳琴 汤长春[2] 刘伟[1] 张良[1] 李睿轩 张翼[1] 

机构地区：[1]湖南师范大学第一附属医院,长沙市410005 [2]湖南省长沙市中心医院,410004

出　　处：《实用医学杂志》2017年第23期3930-3933,共4页The Journal of Practical Medicine

摘　　要：目的探讨导管消融术治疗心动过速型心肌病后心脏左房、左室大小和左室收缩功能的恢复情况。方法收集2012年11月至2017年4月收治的心动过速型心肌病患者15例(男10例,女5例),15例患者均经心腔内电生理检查并在三维标测系统指导下行导管消融。消融后平均随访(2.42±0.63)个月,比较消融前后血清氨基末端脑钠肽前体水平变化以及左房直径、左室舒张末直径、左室射血分数的变化。结果 15例心动过速型心肌病患者中有14例患者消融成功,消融后血清氨基末端脑钠肽前体水平从(3 474.07±3 400.59)pg/mL下降至(497.33±437.84)pg/mL(P=0.005),左室射血分数(%)有显著改善(35.33±6.11 vs.57.93±9.38;P<0.001),术后左室舒张末直径比术前显著缩小(55.47±8.06 vs.49.87±8.99;P<0.001)。术后左房直径比术前明显缩小[(38.87±3.27)mm vs.(35.20±2.46)mm;P<0.001]。结论导管消融治疗心动过速引起的心肌病后,左室收缩功能和心脏左房、左室大小可以恢复,心动过速型心肌病患者中血清氨基末端脑钠肽前体水平升高,消融治疗后血清氨基末端脑钠肽前体水平较前下降。Objective To explore the baseline echocardiographic characteristics and the time course and recovery of left ventrieular systolic function in patients with tachycardia-induced eardiomyopathy. Methods Fif- teen patients received radiofrequeney cather ablation for taehycardiarrhymias from November 2012 to April 2017 were screened in this study. All 15 patients were examined by intracardiac electrophysiology and treated by RFCA under the guidance of three dimensional mapping system. All patients received transthoracic echoeardiography for 3- month follow-up, Levels of NT-proBNP before and after the ablation were compared. Results Successful abla- tion was performed in 14 of 15 patients. There was significant improvement in left ventricular ejection fraction [ （35.33 ± 6.11 ）% vs. （57.93 ± 9.38）%;P 〈 0.001 ]. The LVEDD after treatment had significant differences （55.47 ± 8.06 vs. 49.87 ± 8.99, P 〈 0.001 ） after 3-month follow-up ; the LAD after treatment decreased significantly [ （38.87 ± 3.27 ）mm vs. （ 35.20 ± 2.46 ） mm ; P 〈 0.001 ] and the levels of NT-proBNP decreased after ablation from （3 474.07± 3 400.59）pg/mL to （497.33 ± 437.84 ）pg/mL （P = 0.005 ）. Conclusions Restoration of left ventrie- ular systolic function and reversal of LV remodeling can be achieved with successful elimination of tachycardia in the majority of patients. NT-proBNP level elevates in subjects with TCM and decreases sharply after ablation.

关 键 词：心动过速型心肌病 导管消融 疗效 

分 类 号：R654.2[医药卫生—外科学]