环肺静脉隔离术对阵发性心房颤动患者左心房大小和功能的影响

Effect of circumferential pulmonary vein isolation on left atrial size andfunction in patients with paroxysmal atrial fibrillation

目的:探讨环肺静脉隔离术对阵发性心房颤动(Af)患者左心房大小和功能的影响。方法:28例阵发性Af患者择期行环肺静脉隔离术,根据Af复发与否分为复发组(5例)和未复发组(23例);同期选择窦性心律患者30例作为对照组。应用超声心动图对所有患者在窦性心律下于术前、术后24h、1个月和3个月时测量左心房最大容积(LAVmax)、左心房最小容积(LAVmin)、二尖瓣环晚期运动峰值速度(A峰)、肺静脉收缩期波(S峰)、舒张期波(D峰)、心房血流逆向波(PVa峰),并计算左心房射血分数(LAEF)。结果:①左心房大小:复发组和未复发组患者消融术前LAVmax和LAVmin均较对照组增加(均P<0.05),在术后24hLAVmin均增加(均P<0.01),LAVmax无明显变化;未复发组术后1个月时LAVmax、LAVmin均减小至正常(均P<0.05),术后3个月时未再进一步减小,而复发组术后1个月和3个月恢复至术前大小。②左心房功能:复发组和未复发组消融术前LAEF和A峰值均较对照组降低(均P<0.05),术后24h左心房功能指标均较术前明显降低(均P<0.05);术后1个月时复发组和未复发组左心房功能指标较术后24h均明显增加(均P<0.01),2组PVa峰、S峰和D峰值均恢复至术前正常水平(均P<0.05),LAEF和A峰在未复发组增加至正常水平(P<0.05),而在复发组仅恢复至术前水平;术后3个月时左心房功能指标较术后1个月时均未再有明显变化。结论:环肺静脉隔离术可以逆转阵发性Af造成的左心房大小和功能异常,而且长期对左心房大小和功能无负面影响。

Objective：To evaluate the effect of circumferential pulmonary vein isolation（CPVI） on left atrial（LA） size and function in patients with paroxysmal atrial fibrillation（Af）. Method：Twenty-eight patients with paroxysmal Af who undertaken CPVI guided by EnSite 3000,were divided into 2 groups：recurrence group（n=5） and non-recurrence group（n=23）.Thirty volunteers with sinus rhythm of matched age were enrolled as control group.Echocardiography was performed before CPVI and 24 h,1 month and 3 months after CPVI. Result：LA maximum volume（LAVmax） and LA minimum volume（LAVmin） in patients with paroxysmal Af were significantly increased,compared with control volunteers（both P〈0.05）,whereas mitral peak A wave velocity（VA） and LA ejection fraction（LAEF） were decreased significantly（both P〈0.05）.LAVmax and LAVmin were increased 24 h after CVPI（both P〈0.05）,whereas VA and LAEF were significantly decreased,compared with that before CPVI（both P〈0.01）.One month after CPVI,these changes,which were returned to pre-CVPI levels in recurrence group were reversed to normal levels in non-recurrence group（P〈0.05）.Three months after CPVI,there were no significant differences of these indicators compared with that 1 month after CPVI in both non-recurrence groups and recurrence group. Conclusion：CPVI reverses the left atrial volume and function abnormalities caused by paroxysmal Af in early phase after operation,and do not induce atrial remodling in late phase.