药物治疗与导管消融对心房颤动患者左心房结构、功能及生活质量影响

Effects of catheter ablation and antiarrhythmic drug therapy for atrial fibrillation on left atrial structure,function and quality of life

目的 对比药物治疗与导管消融对心房颤动（房颤）患者左心房结构、功能及生活质量的影响.方法 2012年1月至2013年6月在第三军医大学西南医院心血管内科住院的200例未行导管消融的房颤患者,年龄17～83（56.27±12.98）岁,病程2～68（14.12±11.25）个月.其中72例接受药物治疗（A组）,128例接受三维电解剖标测系统（Carto）指导下消融治疗（B组）,随访3、6个月后对两组患者的左心房结构、功能及生活质量进行比较.结果 经过3个月的随访,A组有69例完成随访,21例维持窦性心律（窦律）（30.4％）.B组有127例完成随访,108例患者维持窦律（85.0％）.独立样本t检验提示：A组的左心室收缩末期左心房最大容积指数（LAVImax）与左心室舒张末期左心房最小容积指数（LAVImin）增大,左心房射血分数（LAEF）减小;B组的LAVImax与LAVImin减小,LAEF增加.A组与B组的一般健康与生活质量明显提高,但B组提高的幅度明显高于A组,3个月后两组的一般健康与生活质量差异有统计学意义（P＜0.01）;A组与B组的心理健康评分均明显增加（P＜0.01）,但两组提高的水平差异无统计学意义.经过6个月的随访,A组的LAVImax、LAVImin较3个月前明显增大,LAEF明显减少（P＜0.05）,但B组的LAVImax,LAVImin较3个月前略有缩小,LAEF略有增加,差异无统计学意义.A组的一般健康与生活质量、心理健康评分较3个月前明显降低（P＜0.05）,但B组的一般健康与生活质量、心理健康评分与3个月前相比差异无统计学意义.结论 导管消融在改善房颤患者的左心房大小、功能及提高生活质量方面优于药物治疗.

Objective To compare the effects of antiarrhythmic drug therapy with catheter ablation for atrial fibrillation （AF） on left atrial structure,function and quality of life. Methods Two hundred AF patients [mean age （56. 27±12. 98） years] were included in this study,72 cases with drug treatment （group A） ,128 cases with Carto guided-catheter ablation （group B）.After 3-month follow-up and 6-month follow-up,the left atrial structure, function and life quality of life were compared between group A and group B. Results During 3-month follow-up,21 patients maintained sinus rhythm （30. 4%） in group A, and 108 patients maintained sinus rhythm （ 85.0% ） in group B.Independent sample t test showed maximal left atrial votume index（LAVImax） and miminal left atrial votume index （LAVImin） increased and left atrial ejection fraction （LAEF） decreased in group A, LAVImax and LAVImin decreased and LAEF increased in group B. General health and quality of life was im- proved significantly in both two groups, group B was better than group A（P〈0. 01）.Mental health scores were also significantly increased in both two groups （P〈0. 01）with no difference between two groups.After 6-month follow-up, LAVImax and LAVImin was increased and LAEF was decreased significantly when compared with 3-month follow-up in group A（P〈0. 05） ,while LAVImax and LAVImin decreased and LAEF increased in group B.General health ,quality of life and mental health scores were decreased significantly compared with 3-month follow-up in group A （P〈 0. 05） ,but no statistical differences in group B. Conclusion Catheter ablation is better than drug therapy in improving left atrial size ,function and quality of life.