环肺静脉电隔离消融和药物治疗阵发性心房颤动对患者左心房大小的影响

Different impacts of circumferential pulmonary vein isolation and antiarrhythrnic drug therapy on size of left atrial in patients with paroxysmal atrial fibrillation

目的了解环肺静脉电隔离消融与抗心律失常药物治疗阵发性心房颤动的疗效和对患者左心房大小的影响。方法101例阵发性心房颤动患者分别采用环肺静脉电隔离消融与抗心律失常药物治疗，其中消融组56例，药物治疗组45例，应用超声心动图观察治疗前及治疗后12个月左房大小的变化。结果平均随访（14．6±2．3）个月，消融组维持窦性心律47例，成功率为83．9％；药物治疗组维持窦性心律22例，成功率为48．8％，消融组窦性心律的维持率明显高于药物治疗组，差异有统计学意义（P〈0．05）。治疗前左心房大小相似，药物治疗成功组患者左房内径虽较治疗前有所减小，但差异无统计学意义（P〉0．05）；消融成功组患者治疗后12个月左房内径较术前及药物治疗成功组均明显减小，差异有统计学意义（P〈0．05）。结论环肺静脉电隔离消融是治疗阵发性心房颤动的有效方法，与药物治疗相比，有较高的窦律维持率，能更有效逆转左房结构重构。

Objective To investigate the different impacts of circumferential pulmonary vein iso-lation and antiarrhythmic drug therapy on effectiveness and size of left atrial in patients with paroxysmal atrial fibrillation（AF）. Methods One hundred and one patients with paroxysmal AF were divided into two groups, radiofrequency catheter ablation group （ n = 56） and antiarrhythmic drug therapy group （ n = 45 ）. Echocardiography was used to examine the left atrial inner diameters of these patients. The data were collected before therapy, and evaluated in 12 months after therapy. Results After a mean follow-up of （ 14. 6 ± 2. 3 ） months, 47 patients were free from AF in radiofrequency catheter ablation group, the success rate was 83.9% ; 22 patients were free from AF in drug treatment group, the success rate was 48.8 %. The success rate of radiofrequency catheter ablation group was significantly higher than that of catheter ablation group（P 〈 0. 05 ）. The left atrial inner diameters were similar in groups before therapy. Twelve months after therapy, there was no significant reduction in left atrial inner diametersin in patients who had sinus conversion by the antiarrhythmic drug procedure （P 〉 0. 05 ）. In eontrast, left atrial inner diametersins decreased significantly in patients who had sinus conversion by radiofrequency catheter abla-tion （P 〈 0. 05 ）. Conclusions Circumferential pulmonary vein isolation is an effective therapy for par-oxysmal AF. Compared with antiarrhythmic drug therapy, it has higher sinus conversion rate and can more effectively reverse morphological remodeling of the left atrial.