射频消融对风湿性二尖瓣狭窄合并持续性心房颤动患者经皮二尖瓣球囊成形术后左心房内径的影响  

Effect of radio frequency ablation on left atrial diameter in patients with rheumatic mitral stenosis complicated with persistent atrial fibrillation after percutaneous mitral balloon valvuloplasty

作　　者：蒋鹤 阮宏云[1] 张毅刚[1] 王森[1] 韩冰[1] JIANG He;RUAN Hong-yun;ZHANG Yi-gang;WANG Sen;HAN Bing(Center of Cardiac Diagnosis and Treatment,Xuzhou Central Hospital,Xuzhou 221009,China)

机构地区：[1]徐州市中心医院心脏诊疗中心,江苏省徐州市221009

出　　处：《中国心血管病研究》2023年第3期274-278,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的探讨射频消融(RFA)对风湿性二尖瓣狭窄(RMS)合并持续性心房颤动(AF)患者经皮二尖瓣球囊成形(PBMV)术后左心房内径(LAD)的影响。方法入选2018年1月至2021年5月在徐州市中心医院心内科诊断为中重度RMS患者23例,所有患者术前均为AF,A组14例患者行PBMV术,B组9例患者行RFA+PBMV术。在三维电解剖系统指导下使用冷盐水灌注消融导管行环肺静脉电隔离,消融终点为全部肺静脉-心房间电隔离。PBMV采用Inoue球囊技术实施。比较两组术前、术后即刻、术后6月、术后12月LAD、二尖瓣瓣口面积等指标,于胸骨旁左室长轴切面在收缩末期测量LAD(前后径)。随访采用门诊随访形式,随访期间复查24 h动态心电图和经胸心脏超声。结果A组患者随访期间均未恢复窦性心律,B组患者术后6月LAD、术后12月LAD较A组患者均减小[术后6月LAD:(39.1±2.6)mm比(45.7±5.9)mm;术后12月LAD:(39.6±2.3)mm比(45.5±4.8)mm],差异均具有统计学意义(P<0.05)。多元线性回归分析后发现,RFA与术后6月LAD具有负相关性(P<0.05),术前LAD与术后6月LAD具有正相关性(P<0.05)。术后6月LAD、术后6月中度及以上二尖瓣反流与患者术后12月LAD具有正相关性(P<0.05)。结论RFA能够降低RMS合并AF患者PBMV术后LAD。Objective To explore the effects of radiofrequency ablation(RFA)on left atrial diameter(LAD)in patients with rheumatic mitral stenosis(RMS)complicated with persistent atrial fibrillation(AF)after percutaneous balloon mitral valvuloplasty(PBMV).Methods A total of 23 patients with moderate to severe RMS in The Department of Cardiology of Xuzhou Central Hospital from January 2018 to May 2021 were enrolled.All the patients had AF before interventional operation.14 patients received PBMV(the group A)and 9 patients received RFA+PBMV(the group B).Circumferential pulmonary vein electrical isolation was performed with cold saline perfusion catheter under the guidance of the three-dimensional electroanatomical system,and the end point of ablation was electrical isolation of all the pulmonary veins and heart rooms.The PBMV was implemented using Inoue balloon technology.The indexes of left atrial diameter(LAD)and mitral valve opening area(MVA)were compared before PBMV,after PBMV,at 6 months and 12 months after PBMV.LAD(anteroposterior diameter)was measured at the end of systole on the parasternal long axis section of the left ventricle.The outpatient follow up was adopted,and 24 hours dynamic electrocardiogram and transthoracic echocardiography were reviewed during the follow-up.Results No sinus rhythm was recovered in the group A during follow-up.LAD at 6 and 12 months after PBMV of the patients in the group B,were smaller than that of the patients in the group A[6 months:(39.1±2.6)mm vs.(45.7±5.9)mm;12 months:(39.6±2.3)mm vs.(45.5±4.8)mm].The differences were statistically significant(P<0.05).Multiple linear regression analysis showed that RFA was negatively correlated with LAD at 6 months after PBMV and LAD before PBMV was positively correlated with the LAD at 6 months after the operation(P<0.05).Moderate or above mitral valve regurgitation(MR)and LAD at 6 months after PBMV were positively correlated with LAD at 12 months after PBMV(P<0.05).Conclusion RFA could reduce the LAD after PBMV in patients with RMS and AF.

关 键 词：风湿性二尖瓣狭窄 持续性心房颤动 经皮二尖瓣球囊扩张 射频消融 

分 类 号：R541.7[医药卫生—心血管疾病]