导管射频消融术对心房颤动左心重构的影响

The influence of radiofrequency catheter ablation on left cardiac chambers remodeling in atrial fibrillation patients

目的 通过超声心动前瞻性观察心房颤动（房颤）患者导管射频消融（RFCA）术后左心重构的变化.方法 为行RFCA术住院的持续性房颤患者,术前、术后即刻、1个月和3个月时进行经胸超声心动检查,不能维持窦性心律者除外.以斑点追踪技术得到左心室应变评价收缩功能,以达峰时间差异（TPSD）评价左心室内部同步性；比较不同随访时间点间超声心动指标差异.结果 22例患者资料满足条件.患者RFCA术后左心室各方向应变改善,射血分数增加[（56.2±6.4）％至（62.8±4.6）％,P＜0.01],纵向应变的TPSD减小[（42.8±17.8）ms至（34.2±16.0）ms,P=0.046）.入选患者术前合并二尖瓣反流者占81.8％,多数为微量反流,术后反流束面积[（2.0± 1.7）cm2至（0.8±1.5）cm2,P=0.001]及其与左心房面积的比值[（8.9±7.4）％至（2.3±4.3）％,P＜0.01）]减小.结论 持续性房颤患者左心室同步性和收缩功能受损,经RFCA术转复并维持窦性心律后逐渐改善.房颤患者合并二尖瓣反流比例较高,维持窦性心律的过程有助于其程度的减轻.

Objective To prospectively observe the reverse remodeling process of left cardiac cham- bers after successful RFCA in patients with atrial fibrillation （AF） by echocardiography. Methods Persis- tent AF patients who were candidates for RFCA were enrolled. The transthoracic echoeardiography examina- tions were conducted before,immediately after, one month and 3 months after the procedure in those who maintained in sinus rhythm after RFCA. Left ventricular strain was obtained by speckle-tracking technology and the time-to-peak standard deviation （TPSD） was used to evaluate the intraventricular synchrony. Com- parisons of the parameters were made among different follow-up time points. Results Altogether 22 patients were studied. After RFCA,left ventricular strains and ejection fraction [ （56.2±6.4）% to （62.8±4.6）% ,P〈 0.001 ] increased significantly. The TPSD of the longitudinal strain decreased [ （42.8 ± 17.8 ）ms to （34.2 ± 16.0）ms, P=0.046]. Mitral regurgitation （MR） was found in 81.8% of the studied population and the ma- jority were trace. The regurgitant jet area （RJA） [ （2.0±1.7）cm2 to （0.8±1.5）cm2, P=0.0011 and its ratio to the left atrial area [ （8.9±7.4）% to（2.3±4.3）%, P〈0.O01 ] decreased significantly. Conclusion Among pa- tients with persistent AF, left ventricular contractive function and intraventrieular synehrony was impaired under AF rhythm while steadily improved after RFCA. Furthermore, MR is highly prevalent in AF patients and the severity of MR can be further alleviated by RFCA.