实时三维超声心动图评价阵发性心房颤动患者射频消融术后右心房大小和机械功能变化

Evaluation of right atrial size and function after radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation using real-time three-dimensional echocardiography

目的 应用实时三维超声心动图评价阵发性心房颤动患者射频消融术后右房大小和机械功能的变化,并探讨右房与左房大小和机械功能变化之间的相关性.方法 35例阵发性心房颤动患者接受射频消融手术.应用实时三维超声心动图、经胸超声心动图及组织多普勒超声心动图分别于术前、术后1月及术后3月测量右房收缩末期容积及面积、右房射血分数、三尖瓣舒张晚期A峰速度、组织多普勒三尖瓣环舒张晚期A＇峰速度、三维右房收缩末期容积、三维右房射血分数、左房收缩末期容积及面积、左房射血分数、二尖瓣舒张晚期A峰速度、组织多普勒二尖瓣环舒张晚期A＇峰速度、三维左房收缩末期容积、三维左房射血分数.结果 35例患者均成功获得满意的三维超声心动图及组织多普勒图像.左房收缩末期面积与三维左房收缩末期容积从术后1月开始即出现了明显的缩小[分别为（18.8±6.3）cm2对（21.5±6.2）cm2,（38.8±17.0）ml对（46.1±20.0）ml,均P＜0.05].心房机械功能方面,三维左房射血分数在术后1月较术前明显下降,到术后3月逐步上升接近术前水平[（41.1±13.7）%对（51.7±15.9）%,（41.1±13.7）%对（45.6±18.3）%,P＜0.05].右房的大小与机械功能的所有参数术后与术前相比差异无统计学意义.术后1月与3月时,右房容积及机械功能的变化与左房容积和机械功能的变化无明显相关性（r值分别为0.23,0.26,0.32,0.03,P＞0.05）.结论 实时三维超声心动图能精确定量心房的容积和机械功能.阵发性心房颤动患者射频消融术后左房明显缩小,而右房大小及机械功能均无明显改变.

Objective To assess the changes of right atrial size and mechanical function after radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation using real-time threedimensional echocardiography（RT-3DE）, and to study the correlation between the changes of left atrial（LA）and right atrial（RA） volume and function. Methods Thirty-five patients with paroxysmal atrial fibrillation were undergone radiofrequency catheter ablation （RFCA） successfully. Transthoracic echocardiography （TTE）,tissue Doppler imaging（TDI） and RT-3DE were performed before, 1 month and 3 months after procedure respectively. Late systolic volume and area of RA and LA,ejection fraction（EF） of RA and LA,late diastolic peak velocity of mitral valve inflow, tricuspid valve inflow and late diastolic peak velocity of mitral annulus and tricuspid annulus were recorded. Results The 3DE images of all patients were satisfied.LA max area and 3DE LA max volume were significantly reduced at 1 months and 3 months after procedure compared with basic stage [ （ 18.8 ± 6.3） cm2 vs （21.5 ± 6.2） cm2 , （38.8 ± 17.0） ml vs （46.1 ± 20.0） ml,P 〈 0.05]. 3DE LA EF also declined markedly at 1 month after RFCA, and restored at 3 months later compared with baseline [（41.1 ± 13.7） % vs （51.7 ± 15.9） %, （41.1 ± 13.7） % vs （45.6 ± 18.3） %, P 〈0.05]. The size and mechanical function of the right atrial after procedure were no obvious changes. There were no evidently correlation between the changes of LA and RA volume and function. Conclusions RT3DE can provide a precise method to quantify the value of atrial volume and function. The LA size and volume are significantly reduced after RFCA in patients with paroxysmal atrial fibrillation, however, the RA size and function are no obvious changes.