射频消融术对老年高血压合并阵发性心房颤动患者左心重构的影响

Left heart structural and functional changes after catheter ablation in old patients with hypertension and paroxysmal atrial fibrillation

目的:探讨经导管射频消融术对老年高血压合并阵发性心房颤动(房颤)患者左心功能的影响。方法:入选年龄≥65岁,高血压合并阵发性房颤的患者,手术组在电解剖标测(CARTO)指导下行经导管环肺静脉前庭线性射频消融电隔离肺静脉(CPVI)手术,药物组给予抗心律失常药物治疗。所有患者均严格降压治疗,控制血压达标(<140/90mmHg,1mmHg=0.133kPa)。随访时间12个月。比较患者入组时及1年随访结束时左心房内径(LA)、左心室舒张末期容积(LVED)、左心室收缩末期容积(LVSD)、左心室射血分数(LVEF)、左心室室间隔厚度(IVS)和后壁厚度(LVPW)以及血N-端脑钠肽前体(NT-proBNP)的变化。结果:手术组共有33例患者完成手术并随访1年以上,药物组共有30例患者完成随访1年以上,所有患者在随访期内血压控制达标。手术组术后4例再发房颤,其中1例于第1次射频消融术后8个月再行射频消融术,其余3例在口服1种抗心律失常药物(胺碘酮或普罗帕酮)情况下可维持稳定的窦性心律;术前及术后1年LA分别为(38.1±2.1)mm及(35.1±1.9)mm(P<0.05),LVED分别为(50.2±2.5)mm及(48.3±1.6)mm(P<0.05),LVSD分别为(31.2±4.0)mm及(28.5±3.2)mm(P<0.05),LVEF分别为(59.6±3.8)%及(60.8±9.7)%(P>0.05),LVPW分别为(11.3±1.1)mm及(10.2±0.8)mm(P<0.05),IVS分别为(11.7±1.0)mm及(10.1±2.0)mm(P<0.05),血NT-proBNP水平分别为(332.3±146.5)pg/ml及(117.8±65.1)pg/ml(P<0.05)。药物组患者均口服1种以上抗心律失常药物,其中9例维持稳定的窦性心律,未发生房颤,其余21例有1次以上发生房颤,其中11例因房颤入院治疗,1例因心力衰竭(心衰)入院治疗;基线及随访结束时LA分别为(38.9±2.2)mm及(40.5±2.7)mm(P<0.05),LVED分别为(50.2±2.5)mm及(51.8±2.3)mm(P<0.05),LVSD分别为(30.5±3.5)mm及(31.5±3.6)mm(P<0.05),LVEF分别为(59.3±3.0)%及(57.3±2.9)%(P<0.05),LVPW分别为(11.0±0.9)mm及(11.4±0.9)mm(P<0.05),IVS分别为(11.4±0.9)mm及(11.7±2.9)mm(P>0.05),血清NTproBNP水平分别为(307.5±171.4)pg/ml及(297.2±184.1)pg/ml(P>0.05)。结论:老年高血压合并阵发性房颤患者行经导管射频消融术后可以降低LA、LVED、LVSD,IVS和LVPW,改善患者左心房和左心室的结构重构。

Objective： To evaluate the changes of left atrium and left ventriculum after catheter ablation in old patients with hypertension and paroxysmal atrial fibrillation. Method：A cohort study was conducted among 63 pa- tients, aged no less than 65 years old, with hypertension and paroxysmal atrial fibrillation. Patients were divided into group A （underwent catheter ablation to isolate the left and right pulmonary, n=33） and group D （treated with antiarrhythmia drugs, n=30）. The follow-up period was twelve months. The left atrial diameter （LA）, the left ventricular end-diastolic and end-systolic volumes （LVED ＆ LVSD）, the left ventricular ejection fraction （LVEF）, the left ventricular posterior wall thickness （LVPW） and the interventricular septal thickness （IVS） were measured echocardiographically. And serum concentration of NT-proBNP was measured by ECLIA. Result： By comparing outcomes of baseline with those of the end of follow-up period in group A showed that.. It was sig- nificantly reduced in LA [（38.1±2.1）mm vs （35.1±1.9）mm,P〈0.05], LVED [（50.2±2.5）mm vs （48.34±1.6）mm,P〈0.05], LVES [（31.2±4.0）mm vs （28.5±3.2）mm,P〈0.05], LVPW [（11.3±1.1）mm vs （10.2±0.8）mm,P〈0.05], IVS [（11.74±1.0）mm vs （10.1±2.0）mm,P〈0.05], and NT-proBNP [（332.3±146.5） pg/mlvs （117.8±65.1）pg/ml, P〈0.05]. There was no difference in LVEF [（59.6±3.8）% vs （60.8± 9.7） % ,P〈0.05]. While in group B showed significantly increased in LA [（38.9±2.2）mm vs （40.5±2.7）mm, P〈0.05], LVED[（50.2±2.5）mm vs （51.8±2.3）mm,P〈0.05], LVES[（30.5±3.5）mm vs （31.5±3.6） mm,P〈0.05]. It was reduced in LVEF[（59. 3±3. 0） % vs（57. 3±2. 9） % ,P〈0.05]. It was increased in LVPW [（11.0±0.9）mm vs （11.4±0.9）mm,P〈0.05]. And there was no difference in IVS[（11. 4±0.9）mm vs （11.7 ±2.9）mm,P〈0.05] and NT-proBNP[（307.5±171.4）pg/ml vs （297.2±184.1）pg/ml,P〉0.05）]. Conclusion： After catheter ablation in old patients with hypertension and paroxysmal atrial fibrillation, it is significantly reduced in LA, LVED, LVES, LVPW and IVS,which reverse the left atrial and ventrieular remodeling.