核素心室显像对心动过速患者射频消融或手术前后的心室功能观察

ASSESSMENT OF VENTRICULAR FUNCTION IN PATIENTS WITH TACHYCARDIAC ARRHYTHMIA BEFORE AND AFTER RADIOFREQUENCY ABLATION USING RDIONUCLIDE VENTRICULOGRAPHY

为了评价射频消融（ＲＦＡ）对心室功能的影响，应用核素心室显像（ＲＮＶ）测定了３８例［３５例为预激综合征（Ｗ－Ｐ－Ｗ）合并室上性心动过速（ＳＶＴ），３例为合并定性心动过速（ＶＴ）］患者ＲＦＡ前后以及２０例正常对照者的心室功能，半自动计算左心室射血分数（ＬＶＥＦ）、右心室射血分数（ＲＶＥＦ）、１／３ＬＶＥＦ、左室高峰充盈率（ＬＶ－ＰＦＲ）、右室高峰充盈率（ＲＶ－ＰＦＲ）．结果提示：窦性心律时．对照组与病人组ＲＦＡ前、后心功能差异无显著性．而１０例Ｗ－Ｐ－Ｗ患者经食道诱发ＳＶＴ以及３例患者经右心导管诱发ＶＴ时，心功能明显下降，与窦性心律时心功能结果比较Ｐ＜０．０１，ＲＦＡ术后又明显改善．由此可见，室上性心动过速或室性心动过速时发生的心功能失调是可逆的．证实核素心室显像评价快速性心律失常患者ＲＦＡ术前、术后心室功能是一种无创伤性的可靠方法．

Abstract To assesa the cffects of radiofrequency ablation (RFA) on ventricular function, 38 patients (35 with W-P-W and supraventricular tachycardia, SVT; 3 with paroxysmal ventricular tachycardia, PVT) and 20 normals (as control) were studied using radionuclide ventriculography (RNV) before and after RFA. RNV was performed using 99mTc RBC (in vivo) and Sicmensγcaincra computer system at ANT, 40°LAO and 70°LAO views. LVEF and RVEF were calculated using semiautomatic program. The results showed that during sinus rhythm, there was no significant difference of ventricular function between control and patients with W-P-W before and after RFA. However, LVEF and RVEF of the 10 patients with W-P-W were significantly reduced during supraventricular tachycardia induced by esophageal pacing (LVEF. 59.9%± 7.0% vs 48.0% ±6.5%, RVEF: 43% ± 6% vs 34.1% ± 6.1%, P<0.01). After catheter ablation,LVEF and RVEF were normal (57.1 %± 8.6% and 43.0%± 5.3%, respectively). In 3 patients with PVT, during sinusrhythm, ventricular tachycardia induced by RV catheter pacing and after RFA, LVEFs were 5 1 .0% ±16.0%, 34.3% ±17.5% and 50.0%± 16.8%, respectively, RVEFs were 30.3%±9.6%, 22.3%±12.6% and 36.0% ±4.5%, respectively.In conclusion: ventricular dysfunction during supraventricular or ventricular tachycardia was reversible after RFA.Ventricular function can be restored to normal. Radionuclide ventriculography was a noninvasive and reliable approach for asaessing ventricular function in patients with tachycardiac arrhythmia before and after RFA.