左心房收缩功能对孤立性心房颤动微创外科射频消融术后复发的影响

Influence of Left Atrial Contraction on Lone Atrial Fibrillation Recurrence after Minimally Invasive Radiofrequency Ablation

目的探讨左心房收缩功能对孤立性心房颤动（房颤）微创外科射频消融术后房颤复发的影响。方法回顾性分析2010年9月至2011年12月上海交通大学附属新华医院心胸外科微创外科射频消融术治疗57例孤立性房颤患者的临床资料,根据术后二尖瓣血流频谱A峰是否缺失,分为A峰缺失组（A组,20例）和A峰存在组（B组,37例）。其中A组年龄（56.32±17.18）岁,女5例;B组年龄（60.33±11.22）岁,女17例。两组均行胸腔镜辅助微创外科射频消融术,记录术前、术后左心房内径（LAD）、左心室射血分数（LVEF）以及二尖瓣血流频谱A峰变化。比较两组临床资料及术后随访结果。结果两组术前各指标差异均无统计学意义（P〉0.05）。随访时间12~26（24.3±8.8）个月。A组术后房颤复发率高于B组（20.0%vs.2.7%,P〈0.05）。全组术后6个月LAD及LVEF较术前改善（P〈0.05）,但A、B组之间差异无统计学意义（P〉0.05）。结论左心房机械收缩功能受损与孤立性房颤微创外科射频消融术后复发有关,二尖瓣血流频谱A峰缺失可能是孤立性房颤微创外科射频消融术后复发的独立预测因子。

Objective To investigate influence of left atrial contraction on lone atrial fibrillation recurrence after minimally invasive radiofrequency ablation. Methods Clinical data of 57 patients with lone atrial fibrillation underwent minimally invasive radiofrequency ablation in Department of Cardiothoracic Surgery, Xinhua Hospital, Medical School of Shanghai Jiaotong University from September 2010 to December 2011 were retrospectively analyzed. According to the absence of mitral A velocity, patients were divided into Group A（absence of mitral A velocity, 20 patients with their age of 56.32±17.18 years, including 5 females） and Group B（mitral A velocity exists, 37 patients with their age of 60.33±11.22 years, including 17 females）. Minimally invasive radiofrequency ablation via thoracoscope were performed in all patients. Preoperative and postoperative left atrial diameter（LAD）, left ventricular ejection fraction（LVEF） and mitral A velocity, as well as clinical and follow-up data were recorded and compared. Results Preoperative clinical characters were not statistically different between two groups（P〉0.05）. All the patients were followed up for 24.3±8.8 months（range, 12-26 months）. Rate of postoperative atrial fibrillation recurrence in group A was significantly higher than that in group B（20.0% vs. 2.7%,P〈0.05）. LAD and LVEF of 57 patients at 6 months after surgery were significantly higher than preoperative LAD and LVEF（P〈0.05）, but there was no statistic difference between two groups（P〉0.05）. Conclusion Damage of left atrial contraction was related to lone atrial fibrillation recurrence after minimally invasive radiofrequency ablation. Absence of mitral A velocity could be a crucial predictor of postoperative lone atrial fibrillation recurrence.