左心房三维结构对老年心房颤动导管射频消融术后影响的研究

Effect of left atrial 3-dimensional structure on senile atrial fibrillation after catheter radiofrequency ablation

目的 探讨左心房三维结构与心房颤动（房颤）类型以及导管射频消融术后房颤复发的相关性.方法 采用回顾性研究方法,选取接受房颤导管射频消融治疗的115例患者,分为阵发性房颤组75例、持续性房颤组25例和长期持续性房颤组15例;另选择同期入院的无房颤患者25例作为对照组.术前采用64层螺旋CT扫描,测量左心房容积（LAV）和左心房前容积（LA-Ant）/LAV比值,并进行术后随访.结果 与对照组比较,阵发性房颤组LAV、左心耳、LA-Ant、左心房后容积（LA-post）和LA-Ant/LAV比值明显升高（P〈0.05）;与阵发性房颤组比较,持续性房颤组LAV、LA-Ant、LA-post明显升高（P〈0.05）;多变量分析显示,LAV（OR=0.965,95%CI：0.937~0.983,P=0.014）和LA-Ant/LAV比值（OR=0.885,95%CI：0.821~0.989,P=0.013）为房颤复发的预测指标.结论 老年性房颤患者,LAV和左心房的不对称是房颤导管射频消融术后复发的预测因素.阵发性房颤、持续性房颤和长期持续性房颤具有左心房逐渐不规则扩张的趋势.

Objective To study the correlation of left atrial （LA） 3-dimensional structure with atrial fibrillation（AF） and its recurrence after catheter radiofrequency ablation. Methods One hundred and fifteen AF patients after catheter radiofrequency ablation were divided into paroxysmal AF group （n = 75）, persistent AF group （n = 25）, and permanent AF group （n = 15）. Twenty-five non-AF subjects served as a control group. Their left atrial volume （LAV） and LA-Ant/LAV ratio were measured by 64-slice spiral CT scanning. The patients were followed up after operation. Results The LAV,LAA and LA-Ant were significantly higher in paroxysmal AF group than in control group （P〈0.05）. The LAV,LA-Ant and LA-post were significantly higher in persistent AF group than in paroxysmal AF group （P〈0.05）. The LAV （OR=0. 965,95% CI. 0. 937- 0. 983,P=0. 014） and the LA-Ant/LAV ratio （OR=0. 885,95;CI.0. 821--0. 989,P=0. 013） were the predictors for the recurrence of AF. Conclusion LAV and left atrial asymmetry are the predicators for the recurrence of AF in senile AF patients after catheter radiofrequency ablation. Paroxysmal,persistent and permanent AF tend to irregularly enlarge the left atrium.