阵发性心房颤动射频消融术后左房大小和机械功能变化

Left atrial size and function after radiofrequency catheter ablation for paroxysmal atrial fibrillation

目的探讨经导管射频消融术对阵发性心房颤动(房颤)患者左房功能的影响,并比较肺静脉口节段性电隔离(SPVI)和环肺静脉消融(CPVA)两种术式在此方面的异同。方法 66例阵发性房颤患者接受射频消融手术治疗。应用经胸心脏超声检查测量患者术前、术后1天、1个月和3个月时的左房前后径、左房面积、舒张晚期跨二尖瓣血流峰速(A 峰)和舒张晚期心肌组织运动峰速(A′峰)。结果 66例患者中,30例接受 SPVI 术,36例接受 CPVA 术。两组患者一般临床情况及术前超声参数相似。术后随访(315±153)d,SPVI 组和 CPVA 组无房性心律失常复发率相似(70%与75%,P=0.650)。两组在手术后左房面积均较术前缩小,SPVI 组发生于术后1个月,而 CPVA 组于术后3个月。SPVI 组左房直径也显示出明显缩小(P<0.05),而 CPVA 组术前和术后则差异无统计学意义。左房机械功能方面,CPVA 组于术后1天 A 峰和 A′峰明显降低(P<0.05),两者均于3个月后较术后1天明显回升,A 峰恢复至术前水平,A′峰较术前有明显升高。SPVI 组术后1天没有出现 A峰和 A′峰明显降低;其 A 峰于术后1个月升高,并保持至3个月;A′峰于术后3个月时升高。结论阵发性房颤经导管 SPVI 术和 CPVA 术治疗后3个月,可以出现左房面积缩小和收缩功能改善。CPVA 术比 SPVI 术造成了更多的左房损伤,表现为术后1天左房功能的下降以及术后左房大小、功能参数改善的延迟。

Objective To evaluate the impact of radiofrequency catheter ablation on left atrial （LA） size and function in patients with paroxysmal atrial fibrillation （PAF） and whether there is any difference between segmental pulmonary vein ostial isolation （SPVI） and circumferential pulmonary vein ablation （CPVA）. Methods Sixty-six patients with highly symptomatic atrial fibrillation were assigned to undergo either SPVI or CPVA. Transthorax echocardiography was performed before, 1 day, 1 months and 3 months after the procedure. LA dimension, LA area, late diastolic peak velocity of mitral valve inflow （A） and peak atrail systolic mitral annulus velocity （A＇） were recorded. Results Of 66 consecutive patients with symptomatic PAF, 30 patients underwent SPVI and 36 underwent CPVA. After a mean follow-up of （315±153） days, 21 patients （70%） after SPVI and 28 patients （75%） after CPVA were free of atrial tachyarrhythmia. As compared with the baseline, LA area decreased at 1-month after ablation in SPVI group and at 3-month in CPVA group. LA dimension decreased also in SPVI group, but did not in CPVA group. A velocity and A＇ velocity declined remarkably 1 day after CPVA, and restored 3 months later. The former went back to the level of baseline, and the latter exceeded it apparendy. In SPVI group, A velocity increased at 1-month, and maintained in 3-month after ablation A＇ velocity increased at 3-month after ablation No reduction of A velocity or A＇ velocity was found after SPVI. Conclusions This study demonstrated a decrease in LA area and an improvement in LA systolic function 3 months after ablation for PAF. The LA damage by CPVA was more than that by SPVI , which was characterized by the reduction of LA function 1 day after procedure and the delayed improvement of LA size and functional parameters.