射频消融术对心肌病阵发性心房颤动患者心脏逆重构的影响

The effect of radiofrequency catheter ablation on cardiac reverse remodeling in cardiomyopathy patients with paroxysmal atrial fibrillation

目的：探讨导管射频消融术（ RFCA ）对心肌病阵发性心房颤动（ PAF）患者心脏结构逆重构及生活质量的影响。方法62例PAF患者[左室舒张末径（ LVEDD）男≥55 mm,女≥50 mm]均行环肺静脉隔离术为RFCA组。同期住院的相匹配的33例患者进行药物频率控制治疗（静息时心室率控制在60~80次/min,活动时〈100次/min）为药物治疗组。入院72 h及心率达标时,术后6个月或频率控制6个月后分别行SF-36量表对患者进行生活质量评分,窦性心律下行经胸心脏彩超检查,测量患者的左房内径（ LAD ）、LVEDD、左室射血分数（ LVEF）。结果 RFCA组患者术后第6个月LVEDD、LAD均较术前减小, LVEF增加差异有统计学意义（P〈0．05）。药物治疗组患者LVEDD、LAD均较术前增加（P〈0．05）,LVEF变化不大。心理健康、躯体疼痛和总健康状况差异无统计学意义。 RFCA组和药物治疗组于社会功能、躯体功能、情感角色、躯体角色和精力有明显改善（ P〈0．05）, RFCA组改善更明显（ P〈0．05）。结论心肌病PAF患者行RFCA术后维持窦性心律可以逆转患者的心脏重构,生活质量得到明显改善。

Objective To explore the effect of radiofrequency catheter ablation（ RFCA） on cardiac reverse remode-ling and improvement of life quality in cardiomyopathy patients with paroxysmal atrial fibrillation（ PAF） . Methods 95 cardiomyopathy patients with PAF were enrolled in our study and divided into two groups. RFCA group：62 patients received circumferential pulmonary vein isolation, （ left ventricular end-diastolic ） LVEDD ≥55 mm （male）, LVEDD ≥50 mm （female）; Drug group：33 patients were treated with drug for controlling heart rate （ resting heart rate around 60~80 bpm, heart rate during daily activity 〈100 bpm） . 72 hours after admission or 6 months after surgery in RFCA group, when the heart rate returned to normal or 6 months after treatment in Drug group, Short-Form36（SF-36） was used to evaluate the quality of living in the patients respectively; transthoracic echocardiography was performed in sinus rhythm;LAD, LVEDD and LVEF of the patients were measured. Results in RFCA group, LAD and LVEDD of 62 patients reduced and LVEF increased in 6 months after surgery statisti-cally significant（P〈0. 05）. In Drug group, 6 months after treatment, LAD and LVEDD of 33 patients increased （ P〈0. 05 ） , without significant change in LVEF. There was no statistical significance in psychological health, physical function and general health perceptions, but there was significant improvement in social function and phys-ical function,affective state, physical role and energy in both RFCA group and drug group （P〈0. 05）, and it was more obvious in RFCA group（P〈0. 05）. Conclusion RFCA can reverse cardiac structural remodeling via sinus rhythm maintenance and improve the quality of life in cardiomyopathy patients with PAF.