心房颤动射频消融治疗前后肺静脉形态结构CT成像改变的临床研究

CT imaging change of pulmonary vein morphology in atrial fibrillation patients before and after radiofrequency ablation

目的:利用CT三维成像技术研究心房颤动(房颤)患者行环肺静脉电隔离术(CPVA)前后肺静脉的形态学变化。方法:房颤患者共28例,行CPVA术(6.5±3.9)个月后进行随访,根据术后有无复发分为成功组(22例)和复发组(6例)。应用64排螺旋CT测量CPVA术前、后肺静脉口的径线、截面积、左心房容积,研究射频消融术后肺静脉的形态学特点并与术前做对比分析。结果:成功组术后左心房容积、左上肺静脉口最大径、右上肺静脉口最大径、右上肺静脉口最小径、右下肺静脉口最大径、右下肺静脉口最小径、4个肺静脉口截面积较术前缩小(P<0.05)。复发组术后仅见右下肺静脉口最大径、左下肺静脉口及右下肺静脉口面积较术前减少(P<0.05)。CPVA术后肺静脉的最大径及最小径狭窄率小于50%者分别为61.6%及56.3%;狭窄率50%～70%者分别为3.6%和5.4%。结论:(1)CPVA成功后可逆转房颤患者的肺静脉和左心房重构,而复发组未出现明显逆重构。(2)CPVA术后可引起部分患者无症状性肺静脉狭窄。

Objective To observe the morphological changes of circumferential pulmonary vein ablation （CPVA） for atrial fibrillation （AF） on the structure of pulmonary vein before and after radiofrequeney ablation by CT three-dimensional image technique. Method 28 patients with AF who underwent CPVA were followed-up after （6.5 ± 3.9） months. The patients were divided into 2 groups： successful group （22 patients） and recurrence group （6 patients） according to the recurrence of AF. Analyze the differences between preoperative and postoperative pulmonary vein morphology. Pulmonary vein diameters, cross-sectional area and left atrial volume were measured before and after CPVA using 64-slice multidector computed tomography （CT）. Result In successful group, compared with preablation, left upper pulmonary vein maximum diameter, right upper pulmonary vein maximum diameter, right upper pulmonary minimum diameter, right lower pulmonary vein maximum diameter, right lower pulmonary minimum diameter, the four pulmonary vein cross-section areas and left atrial volume were redueed（P 〈 0.05） after CPVA, while there were no significant difference in left upper pulmonary minimum diameter, left lower pulmonary vein maximum diameter, left lower pulmonary minimum diameter （P 〉 0.05）. In recurrence group, compared with preablation, right lower pulmonary vein maximum diameter, left lower pulmonary vein cross-section areas and right lower pulmonary vein cross-section areas were reduced （P 〈 0.05） after CPVA, while other pulmonary minimum indexes and left atrial volume were no significant difference （P 〉 0.05）. Stenosis of pulmonary vein maximum diameter and pulmonary minimum diameter less than 50% respectively were 61.6% and 56.3% after CPVA. Stenosis reached 50% and 70% respectively were 3.6% and 5.4%. Conclusions （ 1 ） The reconstruction of pulmonary vein and left atrial can be reversed after CPVA in patients with AF, while there is no significantly reverse remodeling in the recurrence group. （2） Some patients may suffer asymptomatic pulmonary vein stenosis after CPVA.