老年心房颤动患者左心房内径及其电活动变化的临床研究

Clinical study on changes of left atrial diameter and electrophysiological characteristics in old patients with atrial fibrillation

目的探讨老年心房颤动(房颤)患者左心房内径、电活动变化及其意义。方法142例老年非瓣膜性房颤患者(房颤组)进行彩色多普勒超声心动图仪及三导心电图仪检查,测定左心房内径(LAD)、左心室舒张期末内径、左心室后壁厚度、室间隔厚度、左心室射血分数(LVEF)及房颤的检出。采用食管调搏的方法测定左心房电生理特性,以400ms起搏周长(PCL)对左心房进行S1S2扫描,测定基础状态左心房有效不应期(LAERP);以3种不同起搏周长(400、500、600ms)对左心房进行S1S2扫描,观察LAERP频率适应性。150例健康体检者为正常对照组。结果房颤组患者LAD较正常对照组显著增加,其中左心房扩大(LAD>32mm)者占95.07%,且持续性房颤患者LAD较阵发性房颤患者显著增加。左心室肥厚患者LAD较无左心室肥厚患者显著扩大,左心房扩大与心功能降低有关,其中左心房显著扩大者(LAD≥40mm)其LVEF、每搏输出量下降最明显。房颤组患者LAERP较正常对照组显著缩短,LAERP频率适应性较正常对照组减退。结论LAD扩大及其电重构与房颤发生密切相关,LAD扩大与左心室肥厚及心功能减退有关。

Objective To investigate the changes of left atrial diameter （LAD） and left atrial electrophysiological characteristics （electrical and structural remodeling） and their significance in old patients with atrial fibrillation（AF）. Methods 142 atrial fibrillation patients aged 68.7 ± 11.67 years in average,99 males and 43 females, were examined with echocardiography and left atrial pacing for LAD, septal thickness （IVST）, left ventricular posterior wall thickness （LVPWT）, ejection fraction （LVEF）, E/A ratio and left atrial effective refractory period（LAERP）. Results LAD was enlarged in atrial fibrillation patients, and was larger in persistent atrial fibrillation patients with LVH or heart failure than in paroxysmal atrial fibrillation patients. LAERP was significantly shorter in AF group than in the control group. Conclusion Enlarged LA and shortened LAERP may play important role in development of AF and increased LAD may be related to LVH and cardiac dysfunction.