心律失常诱导的心肌病导管射频消融结果与随访  

Results and long-term follow-up of radiofrequency catheter ablation for arrhythmia-induced cardiomyopathy

作　　者：程宽 陈庆兴 庞晹 徐烨 凌云龙 刘桂剑 朱文青 CHENG Kuan;CHEN Qingxing;PANG Yang;XU Ye;LING Yunlong;LIU Guijian;ZHU Wenqing(Department of Cardiology,Zhongshan Hospital,Fudan University,Shanghai Institute of Cardiovascular Diseases,Shanghai,200032,China)

机构地区：[1]复旦大学附属中山医院心内科上海市心血管病研究所,上海200032

出　　处：《临床心血管病杂志》2021年第3期229-233,共5页Journal of Clinical Cardiology

基　　金：上海市科学技术委员会科研计划项目(No:17DZ1930102、17DZ1930303)。

摘　　要：目的:探讨心律失常诱导的心肌病(AIC)导管射频消融(RFCA)治疗效果与长期预后。方法:选择2013年1月—2017年12月收治的AIC患者14例,进行临床评估和RFCA手术,并长期随访观察病情演变和预后。结果:14例AIC患者中,心动过速7例(50.0%),包括房室折返性心动过速(AVRT)2例(14.3%),左心耳起源房性心动过速(AT)2例(14.3%),心房颤动(房颤)3例(21.4%),频发室性期前收缩(室早)7例(50.0%)。1例左心室顶部心外膜起源室早消融失败,其余病例均成功。RFCA术前,心动过速患者的纽约心功能分级(NYHA)差于室早患者(1.4±0.2∶2.9±0.4,P<0.05),心室率快于室早患者[(72.1±3.1)次/min∶(139.0±13.5)次/min,P<0.01]。RFCA术后3个月时,心动过速患者心室率较术前降低[(139.0±13.5)次/min∶(79.7±9.8)次/min,P<0.01]。与术前相比,14例患者术后3个月时心率[(105.6±36.0次/min∶(76.1±7.8)次/min,P<0.01]、左心室舒张末期内径(LVEDd)[(58.5±8.7)mm∶(53.4±6.3)mm,P<0.01]、左心室射血分数(LVEF)[(43.4±6.6)%∶(57.1±4.9)%,P<0.01]、NYHA分级(2.1±0.9∶1.1±0.4,P<0.01)均恢复正常或接近正常。随访(54.1±18.7)个月,初始RFCA成功者均无心律失常复发,14例患者的NYHA分级、LVEDd、LVEF等指标保持稳定,共8例(57.1%)患者停用药物,无心功能恶化、猝死发生。结论:AIC患者通过RFCA以及药物治疗去除或控制心律失常后,左心室功能可完全或明显恢复,长期预后良好,部分患者可避免长期药物治疗。Objective:To investigate the effects and long-term prognosis of radiofrequency catheter ablation(RFCA)in patients with arrhythmia-induced cardiomyopathy(AIC).Methods:Eleven patients with AIC admitted from January 2013 to December 2017 were selected for clinical evaluation and RFCA.Long term follow-up was conducted to observe the disease evolution and prognosis.Results:Among the 14 patients with AIC,tachycardia occurred in 7 cases(50.0%),including 2 cases(14.3%)with atrioventricular reentrant tachycardia(AVRT),2 cases(14.3%)with atrial tachycardia(AT)origin from left atrial appendage,3 cases(21.4%)with atrial fibrillation(AF);and frequent premature ventricular contractions(PVCs)occurred in 7 cases(50.0%).One case with PVCs origin from left ventricular summit failed in ablation,and the other cases were successful.Before RFCA,NYHA grade was worse(1.4±0.2 vs 2.9±0.4,P<0.05),and the ventricular rate was faster([72.1±3.1]beats/min vs[139.0±13.5]beats/min,P<0.01)in patients with tachycardia than those in patients with PVCs.Three months after RFCA,the ventricular rate in patients with tachycardia was lower than that before ablation.Three months after operation,the heart rate([105.6±36.0]beats/min vs[76.1±7.8]beats/min,P<0.01),left ventricular end diastolic diameter(LVEDd)([58.5±8.7]mm vs[53.4±6.3]mm,P<0.01),left ventricular ejection fraction(LVEF)([43.4±6.3]%vs[57.1±4.9]%,P<0.01),and NYHA grade(2.1±0.9 vs 1.1±0.4,P<0.01)returned to normal or nearly normal in all 14 patients.Followed up for(54.1±18.7)months,no arrhythmia recurred in patients with successful initial RFCA.The NYHA grade,LVEDd,and LVEF in all 14 patients remained stable.Eight patients(57.1%)discontinued the drug therapy,and no cardiac function deterioration or sudden death occurred.Conclusion:After removing or controlling arrhythmia by RFCA and drug therapy,the left ventricular function in patients with AIC can be completely or significantly recovered,the long-term prognosis is optimistic,some patients can avoid long-term drug therapy.

关 键 词：心律失常诱导的心肌病 心动过速心肌病 导管射频消融 室性期前收缩 心动过速 

分 类 号：R541.7[医药卫生—心血管疾病]