环肺静脉前庭电隔离术对慢性心力衰竭合并心房颤动患者生活质量的影响

Effect of circumferential pulmonary vein atrial isolation on quality of life for atrial fibrillation in patients with chronic heart failure

目的：探讨以环肺静脉电隔离为主要术式的导管消融治疗对慢性心力衰竭（心衰）合并心房颤动（房颤）患者心功能及生活质量的影响。方法：入选接受导管消融治疗的慢性心衰合并持续性房颤患者33例为研究对象。在Carto系统指引下进行环肺静脉前庭消融术,消融线距离肺静脉口部20~30mm。以心房-肺静脉间电传导完全被阻滞作为消融终点,术前、术后1周及术后6个月行二维心脏超声检查,测定左房内径（LAD）、左室舒张末期内径（LVD）及射血分数（EF）,评价心功能变化。同时应用生活质量评价量表SF-36评价患者术后生活质量情况。结果：所有患者均顺利完成双侧肺静脉完全电隔离,无一例出现严重并发症。平均随访（12.8±5.4）个月,复发6例（3个月空白期后）,有2例进行了二次消融,未再复发。与术前比较,术后1周LAD、左室EF及各项生活质量评分均无明显变化（P〉0.05）,与术后6个月相比有显著的统计学差异（均P〈0.05）。结论：环肺静脉前庭电隔离术治疗慢性心衰合并房颤患者是安全、有效的,可恢复窦性心律、逆转心房重构、增加左室舒张末期容积,改善患者心功能,提高患者生活质量。

Objective：To investigate the effects of circumferential pulmonary vein atrial isolation（CPVI）on quality of life and ventricular function for patients with persistant atrial fibrillation and chronic heart failure.Method：Thirty-three consecutive patients with heart failure and persistant AF who underwent CPVI procedure were analyzed.The circumferential pulmonary vein atrial isolation（CPVI）as the basic operation was guided by Carto,and the ablation line were located within 20-30 mm outside the PV ostium.The end point was complete electric conduction block between atria and pulmonary vein.Cardiac structure and function were assessed by echocardiography at baseline,1-week and 6-month after ablation.The postoperative QOL were evaluated by Short-Form life survey-36items（SF-36）.Result：All operation were completed successfully,and there were no serious complications.The ablation endpoints were attained in all patients.During a mean follow-up of（12.8±5.4）months,6patients with AF experienced late recurrences after three months without period;2patients received re-ablation,with no recurrences.Compared with preoperation,left atrial diameter（LAD）,QOL,and left ventricular ejection fraction（LVEF）did not change significantly 1-week after ablation（P〉0.05 for all）;but significant differences were seen in 6-month after ablation（P〈0.05 for all）.Conclusion：The circumferential pulmonary vein antral isolation（CPVI）as the basic operation were safe and effective for atrial fibrillation in patients with chronic heart failure,with cardiac function and quality of life improved.