射频消融术治疗心动过速性心肌病的临床研究  

Clinical study on the safety and clinical efficacy of radiofrequency ablation in treatment of tachycardia-induced cardiomyopathy

作　　者：韩建妙[1] 齐书英 王建军[2] 张国瑞[2] 朱娜娜 HAN Jianmiao;QI Shuying;WANG Jianjun(Department of Executive Health,The Third Hospital of Shijiazhuang City,Hebei,Shijiazhuang 050011,China)

机构地区：[1]河北省石家庄市第三医院干部保健二科,050011 [2]河北省石家庄市第三医院心内一科,050011 [3]中国人民解放军联勤保障部队第980(白求恩国际)医院

出　　处：《河北医药》2019年第14期2091-2095,共5页Hebei Medical Journal

基　　金：河北省科技支撑计划项目(编号:142777119D)

摘　　要：目的探讨导管射频消融术(RFCA)治疗心动过速性心肌病(TIC)的安全性及临床疗效。方法选取经心电图和超声心动图证实快速心律失常、左心房和(或)左心室增大,心功能减低(EF<50%)的单纯性心动过速性心肌病患者20例,经RFCA治疗后随访6个月,观察术前,术后后3、6个月的心率和窦性心律维持情况、抗心律失常和抗心衰药物使用率、心胸比率(CTR)、左心室射血分数(LVEF)、左心房前后径(LAD)、左心室舒张末期内径(LVEDD)、血浆N末端脑钠肽前体(NT-proBNP)水平以及6min步行距离(6-MWT)改善情况。结果1例右心耳房速患者射频消融手术失败,1例持续性房颤患者术后3个月复发,长期口服药物治疗,心室率控制在70~90次/min,18例患者术后转复为窦性心律,手术成功率90%。术后1例患者出现股动脉血肿经压迫后好转,所有患者术中、术后无心包填塞、冠状动脉损伤等严重并发症。射频消融术后3个月与术前比较Ⅰ级心功能比例增多,心率、抗心律失常和抗心衰药物应用率均下降,CRT、LAD、LVEDD缩小、NT-proBNP下降、LVEF及6-MWT提高,2组比较差异均有统计学意义(P<0.05);术后6个月与术后3个月比较Ⅰ级心功能比例进一步增多,抗心律失常和抗心衰药物应用率进一步下降,CRT、LAD、LVEDD进一步缩小、6-MWT进一步下降、LVEF及进一步提高,差异均有统计学意义(P<0.05)。结论射频消融术治疗心动过速性心肌病安全有效,值得临床推广。Objective To investigate the safety and clinical efficacy of radiofrequency catheter ablation(RFCA) in treatment of tachycardia-induced cardiomyopathy(TIC).Methods A total of 20 patients with TIC,with the left atrium and/or the left ventricle enlargement and cardiac dysfunction(LVEF<50%) who were diagnosed by electrocardiogram and echocardiography were enrolled in the study.The patients were follwed up for 6 months after RFCA,then the heart rate and sinus rhythm maintenance status,anti-arrhythmia and anti-heart failure drug utilization rate,cardiothoracic ratio(CTR),left ventricular ejection fraction(LVEF),anteroposterior diameter of left atrium(LAD),left ventricular end-diastolic diameter(LVEDD),the levels of N-terminal pro-B-type natriuretic peptide(NT-proBNP) and 6-minute walking test improvement status(6-MWT) were compared before and at 3 m,6 m after treatment.Results RFCA failed in 1 patient with right atrial tachycardia,and 1 patient with persistent atrial fibrillation had recurrence at 3 months after operation,with long-term oral drug therapy,and patient’s heart rate was controlled at 70 ~ 90 bpm.And 18 patients were returned to sinus rhythm after operation,with operation success rate being 90%.Moreover 1 patient had femoral artery hematoma after operation.There were no pericardial tamponade,coronary artery injury and other serious complications in all the patients.After RFCA,the proportion of NYHA ClassⅠwas increased,the heart rate and the drug use rate of anti-arrhythmia and anti-heart failure were decreased.The CRT,LAD,LVEDD,NT-proBNP were decreased,however,LVEF and 6-MWT were increased at 3 months after operation.Furthermore,the proportion of NYHA ClassⅠwas increased further at 6 months after operation,and the drug use rates of antiarrhythmia and anti-heart failure were decreased further,moreover,the CTR,LAD,LVEDD and NT-proBNP were decreased further,however,the levels of LVEF and 6-MWT were increased significantly(P<0.05).Conclusion RFCA is safe and effective in treatment of TIC,therefor,it is w

关 键 词：快速性心律失常 心动过速性心肌病 射频消融术 临床效果 

分 类 号：R542.2[医药卫生—心血管疾病]