不同消融策略治疗持续性心房颤动对左心房结构与功能的影响

Effects of different radiofrequency catheter ablation strategies on left atrial structure and function in patients with persistent atrial fibrillation

目的观察并比较环肺静脉隔离（CPVI）和线性消融，基础上结合或不结合心房碎裂电位（CFAEs）消融治疗持续性心房颤动（PAF）术后患者左心房结构和功能的变化。方法入选2010年10月至2012年10月在青岛大学医学院附属医院诊断为PAF患者69例，分别行CPVI＋CFAEs＋线性（Linear）消融（A组）或CPVI＋Linear消融（B组）治疗，于术前、术后12个月行超声心动图检查，并根据随访结果进一步分为治疗有效组（A1组与B1组）、复发组（A2组与B2组），测量并比较左心房容积（LAY）、二尖瓣环舒张晚期峰值速度（Va），并使用二维斑点追踪成像（2D．STI）技术测量并比较A．组和B1组患者左心房各壁的收缩期、舒张早期、舒张晚期左心房峰值应变率（SRs、SRe、SRa）。结果60例患者完成随访，结果如下：①A，组与B，组的LAV与本组术前比较明显减小，Va明显升高（P〈0．05）；A，组与B2组的LAV、Va与本组术前比较，差异无统计学意义（P〉0．05）；②术后12个月，B，组的LAV、Va与A，组比较，差异无统计学意义；③术后12个月，B1组的前壁、下壁的SRs、SRa均高于A，组（P〈0．05）。结论不同术式治疗PAF有效者均可以使其LAV减小，左心房总体功能改善，虽然两组治疗有效者之间比较差异无统计学意义，但通过2D-STI观察发现，CPVI＋Linear消融治疗有效者的左心房前壁、下壁的收缩与舒张功能优于结合CFAEs消融的患者。

Objective To observe and compare the functional and structural changes of the left atrium after treated with CPVI plus atrial linear ablation combined with complex fractionated atrial electrograms （CFAEs） ablation or not in patients with persistent atrial fibrillation （PAF）. Methods Sixty-nine patients with PAF were treated with CPVI＋CFAEs＋Linear ablation（ group A） or CPVI＋Linear ablation（ group B）. After 12 months of follow-up, the two groups were divided into the effectively controlled group（ group A1 and group B1 ） and the recurrence group （ group A2 and group B2 ） according to the clinical effects. The left atrial volume （LAV） ,peak atrial systolic mitral annulus velocity （Va） were measured by echocardiography before and 12 months after the ablation, respectively. The average peakstrain rate of systolic, early and late diastolic phase （SRs, SRe, SRa） of the different left atrial walls were calculated by two-dimensional speckle tracking imaging （2D-STI） in patients of group A1 and group BI. Results Sixty patients completed the follow-up of（ 12. 45 ± 2. 05）months. The results were as follows：①About 12 months after the ablation, the LAV decreased and the Va increased compared with that before ablation in both group A1 and B1, （P〈0.05） ;while the difference had no statistical significance in group A2 and B2（ P〉0.05 ）. ②About 12 months after ablation, the difference of the LAV and Va between group B1 and Al had no statistical significance（ P〉0. 05 ）. ③About 12 months after ablation,the SRs and SRa of the anterior and inferior wall of the left atrium were higher in group B1 compared with that in group A1 （ P〈0. 05 ）. Conclusion Left atrium reversal remodeling and functional improvement occurred in the patients with PAF treated effectively with either of the two different ablation strategies ,while no statistical significance was found between the two groups 12 months after the procedure. The systolic and diastolic functions of the anterior and inferior wall of the left atrium were better in the CPVI＋Linear group measured by 2D- STI.