射频消融对心室预激患者左心房压力负荷及左心室舒张功能的影响  

Effects of radiofrequency ablation of left-side accessory pathway on left atrial pressure and left ventricular diastolic function in patients with ventricular preexcitation

作　　者：徐光泽 陈治奎[1] 林海燕 沈文均[1] 葛世俊[1] XU Guangze;CHEN Zhikui;LIN Haiyan;SHEN Wenjun;GE Shijun(Department of Cardiology,Li Huili Hospital of Ningbo Medical Center,Ningbo 315043,China)

机构地区：[1]宁波市医疗中心李惠利医院心血管内科,315043

出　　处：《心电与循环》2021年第3期238-244,共7页Journal of Electrocardiology and Circulation

基　　金：浙江省医药卫生科技计划项目(2019KY186);宁波市自然科学基金立项项目(202003N447)。

摘　　要：目的探讨射频消融对心室预激患者左心房压力(LAP)负荷及左心室舒张功能的影响。方法选取2015年1月至2020年1月在宁波市医疗中心李惠利医院成功完成左侧显性旁路射频消融的左侧心室预激患者71例,其中有心房颤动史9例,有心动过速病史63例。经胸超声测定射频消融前后舒张早期二尖瓣口血流速度峰值(EMIVpeak),经导管穿刺房间隔测定LAP的峰值(LAPpeak)、谷值(LAPnadir)及平均值(LAPmean),比较消融前后上述指标的变化;分析消融后LAPmean下降的预测因素。结果与消融前比较,射频消融后LAPpeak、LAPnadir、LAPmean均明显降低(均P<0.05),二尖瓣舒张早期血流速度与舒张晚期血流速度的比值(E/A)、EMIVpeak均明显升高(均P<0.05)。经线性回归模型分析,有心房颤动史、消融前射血分数(EF)是射频消融后LAPmean下降的独立预测因子(均P<0.05)。结论射频消融心室预激患者左侧旁道有助于降低LAP负荷,改善左心室舒张功能。Objective To assess the effects of radiofrequency ablation(RA)of left-side accessory pathway on left atrial pressure(LAP)and left ventricular diastolic function in patients with ventricular preexcitation.Methods A total of 71 patients with left-side accessory pathway ablated successfully via atrial septal approach from January 2015 to January 2020 in Li Huili Hospital of Ningbo Medical Center were enrolled.Of them,9 patients had a history of atrial fibrillation(AF)and 63 patients had a history of tachycardia.The peak early diastolic mitral inflow velocity(EMIVpeak)was measured by thoracic ultrasound before and after RA.The peak LAP(LAPpeak),nadir LAP(LAPnadir)and mean LAP(LAPmean)were measured by transseptal puncture approach.The changes of above measurements before and after RA were compared.The predictors of LAPmean decrease after ablation were analyzed.Results LAPpeak,LAPnadir and LAPmean decreased and the ratio of early diastolic mitral velocity to late diastolic mitral velocity(E/A)and EMIVpeak increased significantly post ablation compared with the pre ablation values(all P<0.05).A multivariate linear regression analysis revealed that pre ablation left ventricular ejection fraction and a history of AF were independent predictors of LAP decrease after RA(P<0.05).Conclusion RA of left-side accessory pathway in patients with ventricular preexcitation may reduce LAP and improve left ventricular diastolic function.

关 键 词：心室预激 左心房压力 心房颤动 射频消融 

分 类 号：R541.75[医药卫生—心血管疾病]