心力衰竭合并持续性心房颤动患者导管射频消融的回顾性研究  

R54Retrospective study of radiofrequency catheter ablation in patients with heart failure and atrial fi brillation

作　　者：熊玉玲 王志燕 华畅 汤阳阳 刘欣茹 吕强[1] 董建增[1] 杜昕[1] XIONG Yu-ling;WANG Zhi-yan;HUA Chang;TANG Yang-yang;LIU Xin-ru;LÜQiang;DONG Jian-zeng;DU Xin(Heart Failure Center,Beijing Anzhen Hospital Affi liated to Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心力衰竭中心,北京100029

出　　处：《中国介入心脏病学杂志》2024年第12期683-688,共6页Chinese Journal of Interventional Cardiology

基　　金：北京市自然科学基金项目(171100006817001)。

摘　　要：目的 探讨左心室射血分数(LVEF)≤35%心力衰竭合并持续性心房颤动或心房扑动患者行导管射频消融的安全性和有效性。方法 回顾性纳入2018年1月至2024年3月期间在首都医科大学附属北京安贞医院心力衰竭中心接受导管射频消融治疗的心力衰竭(LVEF≤35%)合并持续性心房颤动/心房扑动患者,分析患者消融特征、围术期并发症、超声心动图参数变化和随访结局等。结果 共纳入45例患者,平均年龄为(56±13)岁,术前平均LVEF为(28±4)%。消融策略为双肺静脉电隔离加经验性线性消融,手术时间和透视时间分别为120(120,163)min和5(4,10)min,入选患者主要进行了环肺静脉隔离38例(84.4%)、三尖瓣环峡部线37例(82.2%)、左心房顶部线34例(75.6%)、二尖瓣环峡部线34例(75.6%)及Marshall静脉无水酒精化学消融21例(46.7%)等线性消融,24例(53.3%)患者术中行电复律转复。所有患者术后即刻均恢复窦性心律,且均未发生围术期并发症。中位随访22.9 (7.8,31.0)个月,2例患者心血管死亡,1例患者接受了心脏移植,14例(33.3%)患者因心血管疾病再次住院,10例(23.8%)患者心房颤动复发。末次随访获得LVEF的28例患者平均LVEF从术前(28±4)%上升至术后(51±14)%,LVEF平均改善为(23±13)%(P<0.0001),其中15例患者左心室收缩功能完全恢复(LVEF≥50%)。结论 对于心力衰竭(LVEF≤35%)合并持续性心房颤动/心房扑动患者,接受导管射频消融安全有效,能改善患者心功能,显著提高LVEF。Objective To explore the safety and effi cacy of radiofrequency catheter ablation(RCFA)in patients with persistent atrial fibrillation(AF)/atrial flutter(AFL)and heart failure(HF)with left ventricular ejection fraction≤35%.Methods This study is a retrospective study.Patients with persistent AF/AFL and HF with left ventricular ejection fraction≤35%admitted to Beijing Anzhen Hospital from January 2018 to March 2024 were enrolled.The perioperative characteristics and complications changes in echocardiographic parameters,and follow-up outcomes were analyzed.Results A total of 45 patients were enrolled with a mean age of(56±13)years and a mean LVEF of(28±4)%.The ablation strategy was circumferential pulmonary vein isolation and empirical linear ablation.The operation time and fluoroscopy time were 120(120,163)min and 5(4,10)min 12respectively. The patients mainly underwent linear ablation including circumferential pulmonary vein isolation(38,84.4%),cavotricuspid isthmus(37,82.2%),roofl ine(34,75.6%),mitral isthmus(34,75.6%). 21(46.7%)patients underwent ehtanol infusion into the vein of Marshall. 24(53.3%) patients underwent electrocardioversion. All patients restored sinus rhythm immediately after RFCA and had no perioperative complications. After a median follow-up of 22.9(7.8,31.0) months, 2 patients died of cardiovascular disease, 1 patient underwent heart transplantation, 14(33.3%) patients were readmitted for cardiovascular disease, and 10 patients (23.8%) had recurrence of AF.The mean LVEF of the 28 patients who obtained LVEF at the last follow-up increased from(28±4)% to(51±14)%, and the average improvement of LVEF was(23±13)%(P<0.0001). 15 of these patients had complete recovery of left ventricular systolic function (LVEF≥50%). Conclusions RFCA is safe and eff ective for patients with persistent AF/AFL and HF with LVEF≤35%, and can improve patient’s cardiac function and signifi cantly increase LVEF.

关 键 词：心力衰竭 心房颤动 导管射频消融 心功能 左心室射血分数 

分 类 号：R54[医药卫生—心血管疾病]