射频消融频发室性早搏逆转“扩张性心肌病”

Reversal of dilated cardiomyopathy by radiofrequency catheter ablation in patients with frequent premature ventricular contractions

目的评价心脏扩大合并右心室流出道频发室性早搏（室早）的患者行射频消融治疗后心脏大小和功能的变化。方法本文对5例频发右心室流出道室早合并左心室扩大的患者行常规电生理检查及射频消融治疗。所有患者消融术前及术后6个月测定左心室收缩末内径（LVESD）、左心室舒张末内径（LVEDD）、左心室射血分数（LVEF）、心胸比例（CTR）、心功能（NYHA分级）等指标。结果射频消融术前，所有患者均显示LVESD和LVEDD扩大、LVEF下降、CTR增大和心功能减退。成功消融室早后随访6个月，上述指标均获得明显改善。结论频发右心室流出道室早是临床上少数“扩张性心肌病”患者的根本病因，射频消融根治室早后心脏扩大和心功能减退可完全或部分得到逆转。

Objective To evaluate the role of radiofrequency catheter ablation （RFCA） of frequent premature ventricular contractions from right ventricular outflow tract （RVOT-PVCs） on cardiac function in patients with dilated cardiomyopathy. Methods The study consisted of 5 patients with frequent RVOT-PVCs and left ventricular dilation. All patients underwent conventional electrophysiological study and RFCA. Left ventricular end-systolic internal dimension （LVESD） , left ventricular end-diastolic internal dimension （LVEDD）, left ventricular ejection fraction （LVEF）,cardiothoracic ratio （CTR） and New York Heart Association （NYHA） functional class were evaluated before and 6 months after RFCA. Results Before RFCA, all patients demonstrated enlarged LVESD, LVEDD,reduced LVEF,increased CTR, and deteriorated NYHA functional class. The successful elimination of the PVCs by RFCA produced the improvement of all the above abnomal parameters significantly. Conclusion The principal finding of this study is that frequent RVOT-PVCs is an underappreciated cause of dilated eardiomyopathy in some patients that can be completely or partly reversed by successful radiofrequeney catheter ablation.