射频消融治疗对局部心肌组织损伤的研究

Study about myocardial injury after radiofrequency catheter ablation

目的 研究射频消融术 (RFCA)患者术前及术后不同时间血清心肌肌钙蛋白T(cTnT) ,肌酸激酶 (CK) ,肌酸肌酶同功酶 (CK MB)及天冬氨酸转氨酶 (AST)浓度变化及与RFCA诸因素的关系。探讨RFCA对心肌组织损伤程度。方法 采用ELISA一步夹心免疫测定法 ,分别测定 40例阵发性室上性心动过速 (PSVT)患者RFCA术前及术后即刻 ,6h ,12h ,2 4h血清cTnT以及上述心肌酶浓度。结果 RFCA患者cTnT ,CK ,CK MB ,AST均于术后即刻升高 ,术后 6h达到峰值 ,12h下降 ,2 4h除CK外 ,其余均恢复正常 (P均 <0 0 5 )。经相关分析表明cTnT活性变化的峰值升高程度与消融时间 ,平均功率及累计能量均无线性关系 (r=0 .33 ,r =0 .2 5 ,r=0 .2 9,P均 >0 0 5 ) ,而与消融靶点个数高度正相关(r=0 .81,P <0 0 0 1) ,与消融次数也有显著关系 (r=0 .5 1,P <0 0 1)。结论 RFCA对心肌组织确有不同程度的损伤 ,但持续时间短 ,损伤轻 ,恢复快。提示RFCA系安全有效的治疗快速心律失常的方法。测定cTnT可作为临床判断RF CA对心肌损伤的监控指标。

Objective To study the relationship between changes of serum cardiac troponin T(cTnT), creatine kinase (CK) and its MB (CK-MB), aspartate aminotransferase (AST) levels and myocardial injury in patients with paroxysmal superaventricular tachycardia (PSVT) undergoing radiofrequency catheter ablation (RFCA). Methods The levels of substances were measured before, immediately after ablation and every 6 hours thereafter for 24 hours to detect myocardial injury in 40 patients with paroxysmal superaventricular tachycardia (PSVT). Results The levels of the substances were significantly high in the undergoing radiofrequency catheter ablation (RFCA) patients immediately than those before subjects, and there were supreme after 6 hours, decreased after 12 hours and regained normally after 24 hours but CK. The analysis of linear correlation showed that the levels of seum cTnT positively correlated with ablation sites ( r=0.81, P<0 001 ) and ablation frequency ( r=0.51, P<0 01 ), not correlated with ablation time, average power and accumulative energy ( r=0 03, r=0.25, r=0.29, P>0 05 ). Conclusion Radiofrequency catheter ablation (RFCA) for paroxysmal superaventricular tachycardia (PSVT) indeed caused some miner myocardial injury, measurement of the cTnT might be useful to detect myocardial injury in ablation patients with paroxysmal superaventricular tachycardia (PSVT).