射频消融术对室性心律失常早期心功能减退患者左心室收缩和舒张功能的影响  

The effect of radiofrequency ablation on cardiac systolic and diastolic function of left ventricle in patients with cardiac insufficiency caused by ventricular arrhythmias

作　　者：范鲍函 吴红平[1] 徐艳[1] 陈求实 陈信光[1] 陈红武[1] 居维竹[1] 郦明芳[1] 杨刚[1] 陈明龙[1] 张凤祥[1] Fan Baohan;Wu Hongping;Xu Yan;Chen Qiushi;Chen Xinguang;Chen Hongwu;Ju Weizhu;Li Mingfang;Yang Gang;Chen Minglong;Zhang Fengxiang(Department of Cardiology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院心内科,210029

出　　处：《中华心律失常学杂志》2019年第4期315-319,共5页Chinese Journal of Cardiac Arrhythmias

基　　金：国家重点研发计划(2016YFE0117000);江苏省第5期333人才工程课题(BRA2017544);青海省自然基金(2017-ZJ-769).

摘　　要：目的探讨射频消融对室性心律失常早期心功能减退患者左心室收缩与舒张功能的影响.方法连续入选2015年12月至2018年12月在南京医科大学第一附属医院接受射频消融术的室性心律失常[室性早搏(PVC)与室性心动过速(VT)]引起的早期心功能减退患者(n=22),前瞻性观察左心室收缩与舒张功能变化.采用经胸超声心动图检测消融前,术后第3天,1、2、3、6、12个月左心室收缩功能等参数变化,包括左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室射血分数(LVEF)和舒张功能[经二尖瓣左心室舒张早期血流速度与二尖瓣环运动速度比值[(E/Em)],并在术后相应时间点行动态心电图检查,判断心律失常是否复发.结果共22例室性心律失常早期心功能减退患者,男11例,年龄中位数38岁,年龄范围27~49岁.其中PVC患者21例,VT患者1例.22例患者均消融成功.患者术后第3天LVEDD、LVESD及LVEF与术前相比变化差异无统计学意义[LVEDD:(57.2±5.2) mm对(56.7±4.2) mm,P>0.05;LVESD:(41.2±6.3) mm对(40.5±3.7) mm,P>0.05;LVEF:54.4%±7.6%对54.7%±4.7%,P>0.05].术后1个月LVEDD、WESD及LVEF较术前显著改善[LVEDD:(53.5±3.2) mm对(56.7±4.2) mm,P<0.05;LVESD:(36.5±4.3) mm对(40.5±3.7) mm,P<0.05;LVEF:59.4%±6.7%对54.7%±4.7%,P<0.05].术后2个月LVEDD、LVESD及LVEF术前与术后第3天显著改善(P均<0.05).术后3、6与12个月LVEDD、LVESD及LVEF较术前与术后3天显著改善(P均<0.01),但较术后1个月与2个月无显著改善(P均>0.05).术后2、3与12个月E/Em较术后第3天有显著变化(P均<0.05).1例PVC复发,再次消融成功.3例患者术后第12个月失访.结论射频消融术能改善室性心律失常早期心功能减退患者的左心室收缩与舒张功能.左心室收缩与舒张功能1个月时基本恢复.Objective To investigate whether cardiac systolic function of left ventricle improved significantly after radiofrequency ablation in patients with earlier cardiac insufficiency caused by ventricular arrhythmias.Methods This prospective observational study included 22 patients who suffered from ventricular arrhythmias [premature ventricular contraction (PVC),ventricular tachycardia (VT)],and received radiofrequency ablation treatment in Department of Cardiology in the First Affiliated Hospital of Nanjing Medical Universityfrom December 2015 to December 2018.Transthoracic echocardiography was used to evaluate cardiac systolic function [left ventricular end diastolic dimension (LVEDD),left ventricular end systolic dimension (LVESD),left ventricular ejection fraction (LVEF)],and diastolic function [the ratio of early transmitral flow velocity (E) to early mitral annular velocity (Em)(E/Em)] at the times before ablation procedure,then 3rd day,and 1st,2nd,3rd,6th,12th month after ablation procedure,respectively.Holter recording was performed at every follow-up time point.Results This study included 22 patients (11 men),median 38 years old (27-49 years old),who suffered from ventricular arrhythmias.Ablation was successful in all patients (PVC,n=21,VT,n=1).There was no significant difference of LVEDD,LVESD and LVEF between the 3rd day after ablation procedure and baseline [LVEDD:(57.2±5.2) mm vs.(56.7±4.2) mm,P>0.05;LVESD:(41.2±6.3) mm vs.(40.5 ± 3.7) mm,P>0.05;LVEF:54.4%± 7.6% vs.54.7%± 4.7%,P>0.05;respectively].There was significant difference of LVEDD,LVESD and LVEF between the 1st month after ablation procedure and baseline [LVEDD:(53.5±3.2) mmvs.(56.7±4.2) mm,P<0.05;LVESD:(36.5±4.3) mmvs.(40.5±3.7) mm,P<0.05;LVEF:59.4%±6.7 % vs.54.7%±4.7%,P<0.05;respectively].There was also significant difference of LVEDD,LVESD and LVEF between the 2nd,3rd,6th and 12th month after ablation procedure and baseline and the 3rd day after procedure (P all<0.05,respectively).There was no significant difference of LVEDD,LVESD a

关 键 词：导管消融术 室性早搏复合征 心动过速 室性 心律失常性心肌病 

分 类 号：R541.7[医药卫生—心血管疾病]