超声评价阵发性房颤患者环肺静脉消融术前后左心房结构及功能变化

Assessment on left atrial structural and functional before and after circumferential pulmonary vein isolation for paroxymal atrial fibrillation using echocardiography

目的利用无创超声心动图评价阵发性房颤（PAF）患者环肺静脉射频消融术前后左心房结构及功能变化。方法48例接受环肺静脉射频消融治疗的PAF患者术前、术后3d及术后3个月进行常规超声心动图检查。术后3个月仍维持窦性心律者（PAF组）42例及正常对照组35例为该试验研究对象。常规二维超声测定左心房前后径（LAD）、改良Simpson’s法测定左心房最大容积（LAVmax）、左心房最小容积（LAVmin）、左心房P容积（LAVp），计算左心房最大容积指数（LAVImax），左心房最小容积指数（LAVImin）。计算左心房主动射血分数（LAAEF）及被动射血分数（LAPEF）。彩色血流多普勒测定舒张早期跨二尖瓣血流速度（VE）、舒张晚期跨二尖瓣血流速度（VA）及E峰与A峰比值（E／A），组织多普勒记录二尖瓣环间隔侧和左心室侧壁侧左心室舒张早期组织速度VE＇及舒张晚期组织速度Va＇峰值，E／e’比值作为左心室充盈压。结果（1）术后3个月维持窦性心律者42例，6例复发。与对照组比较，PAF组LAD、LAYmax、LAVImax、LAVmin均大于正常对照组（P〈0．05）。PAF组跨二尖瓣环VE、VA、E／A与对照组相比均无明显差异（P〉0．05）；组织多普勒二尖瓣环间隔侧及侧壁侧Va＇及Va＇较对照组均明显降低，E／e’比值增大（P〈0．05）。（2）PAF组射频术后3dLAVmin增大，LAAEF降低，术后3个月LAVmin恢复至术前水平，LAAEF较术前及术后3d明显增加（均P〈0．05）；术前、术后3d及术后3个月的LAD、LAVmax，LAPEF则无明显差异（均P〉0．05）。（3）PAF组跨二尖瓣环VE、VA、E／A术前、术后3d及术后3个月比较均无明显差异（均P〉0．05）；组织多普勒Va术后3d较术前降低，E／e’比值增大，术后3个月Va高于术前，E／e’比值较术前降低（均P〈0．05）。结论房颤射频消融术早期对左心房结构和功能产生不利影响，随着时间推移可逐渐恢复，左心房辅助泵功能得到改善。

Objective To evaluate left atrial structural and functional remodeling in patients with paroxysmal atrial fibrillation（PAF） after circumferential pulmonary vein isolation ablation with echocardiography. Methods 48 patients with PAF were studied at baseline,3 day,and 3 months after pulmonary vein isolation radiofrequency ablation.Of the 48 patients,6 had recurrence during 3 month.Patient in sinus rhythm with normal ventricular function were included in this study.35 healthy controls of similar age and gender were also studied.Echocardiographic measurements of the maximal and minimum left atrial w^lume （LAVmax,LAVmin）, left atrial p volume（LAVp）,left atrial active ejection fraction（LAAEF） and the lef! atrial passive ejection fraction（LAPEF） were measured using Simpson＇s method.The transmitral flow velocity of early diastolic filling wave（E） and later filling wave（A） of mitral annulus were measured.Doppler myocardial velocity e＇and a＇ from septal and lateral mitral annulus were obtained.The ratio of E/c＇ was used as the filling pressure of left ventricle. Results 42 patients maintaining sinus rhythm completed the final follow up. 16 patients had systemic arterial hypertension and 8 patients had diabetes mellitus.Compared with normal controls the left atrial diameter（LAD）,LAVmax,LAVmin LAVImax increased significantly（P〈0.05）.There were no significantly difference between PAF group and the normal control group in transmitral E,A,and E/ A（P〉0.05）.In PAF patients the myocardial velocity of e＇and a＇from lateral and septal decreased and the ratio of E/e＇Increased than that of normal control （P〈0.05）.3 days after ablation,the LAVmin increased and the LAAEF decreased compared with pre-operation （P〈0.05）.3 months after ablation the LAVmin recovered to the level of pre-operation and the LAAEF increased significantly than that of pre-operation（P〈0.05）.There were no significantly difference between pre-operation,3 day,and 3 month in LAD,LAVmax,and LAPEF.There were no significant difference between Transmittal E,A,and E/A ratio;the Doppler myocardial velocity e＇ and a＇ were decreased significantly after 3 day after ablation than pre-operation and increased than the level of pre- operation 3 months after ablation（P〈0.05）. Conclusion Circumferential pulmonary vein isolation ablation have negative impacts on left atrial structure and function in early phase and will recover and improved as time goes on.