心房颤动患者射频消融手术前后左心房结构及功能变化

Left atrial structure and function changes in patients with atrial fibrillation before and after radiofrequency ablation

目的探讨非风湿性心房颤动(non-rheumatic atrial fibrillation,NRAF)患者射频消融手术前后左心房结构及功能的变化。方法 NRAF患者200例,其中100例行射频消融手术者为射频消融组,100例行药物保守治疗者为保守治疗组。2组治疗前及治疗后1a后均行经食管超声心动图检查和血脑钠肽(brain natriuretic peptide,BNP)、高敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)水平检测,比较2组左心房、左心耳结构和功能变化以及血清BNP、hs-CRP水平。结果 2组治疗前左心房内径(left atrial diameter,LAD)、左心房最大容积(left atrial maximum volume,LAVmax)、左心房容积指数(left atial volume index,LAVI)、左心耳最大容积(left atrial appendage maximum volume,LAAVmax)、左心房射血数(left atrial ejection fraction,LAEF)、左心耳射血分数(left atrial appendage ejection fraction,LAA-EF)、左心耳最大排空速度(left atrial appendage emptying maximun speed,LAA-PEV)、左室射血分数(left ventricular ejection fraction,LVEF)及血BNP、hs-CRP比较差异无统计学意义(P>0.05);治疗后1a,2组以上指标均较治疗前改善,且射频消融组LAD[(35.6±3.4)mm]、LAVmax[(66.5±4.4)mL]、LAVI[(72.6±5.4)mL/m^2]、LAAVmax[(4.1±0.5)mL]以及血BNP[(17.80±5.30)ng/L]、hs-CRP[(4.23±1.59)mg/L]低于保守治疗组[(39.2±2.1)mm、(72.7±3.1)mL、(89.4±2.7)mL/m^2、(4.5±0.6)mL、(30.10±6.30)ng/L、(5.50±2.20)mg/L],LAA-PEV[(38.1±6.5)cm/s]、LAA-EF[(22.2±3.5)%]、LAEF[(55.6±5.3)%]、LVEF[(65.0±1.4)%]高于保守治疗组[(33.6±7.3)cm/s、(20.2±3.1)%、(51.1±5.7)%、(60.1±1.1)%],2组比较差异均有统计学意义(P<0.05)。结论导管射频消融术可逆转NRAF患者左心房和左心耳结构及功能。

Objective To evaluate the changes of left atrial structure and function in patients with non-rheumatic atrial fibrillation before and after radiofrequency ablation.Methods Totally 200 patients with non-rheumatic atrial fibrillation were divided into observation group receiving radiofrequency ablation and control group receiving conservative treatment,with 100 patients in each group.Both two groups underwent transesophageal echocardiography and were detected the levels of brain natriuretic peptide（BNP）and high sensitivity C-reactive protein（hs-CRP）before and one year after treatment.The structure and function of left atrium and left atrial appendage,and changes of BNP and hs-CRP were compared between two groups.Results There were no significant differences in left atrial diameter（LAD）,left atrial maximum volume（LAVmax）,left atial volume index（LAVI）,left atrial appendage maximum volume（LAAVmax）,left atrial ejection fraction（LAEF）,left atrial appendage ejection fraction（LAA-EF）,left atrial appendage emptying maximun speed（LAA-PEV）,left ventricular ejection fraction（LVEF）,serum BNP,hs-CRP between observation group and control group before treatment（P〉0.05）.After one-year treatment,the above indexes were improved in both two groups,LAD（（35.6±3.4）mm）,LAVmax（（66.5±4.4）mL）,LAVI（（72.6±5.4）mL/m^2）,LAAVmax（（4.1±0.5）mL）,BNP（（17.80±5.30）ng/L）and hs-CRP（（4.23±1.59）mg/L）were significantly lower in observation group than those in control group（（39.2±2.1）mm,（72.7±3.1）mL,（89.4±2.7）mL/m^2,（4.5±0.6）mL,（30.10±6.30）ng/L,（5.50±2.20）mg/L）,and LAA-PEV（（38.1±6.5）cm/s）,LAA-EF（（22.2±3.5）%）,LAEF（（55.6±5.3）%）and LVEF（（65.0±1.4）%）in observation group were significantly higher than those in control group（（33.6±7.3）cm/s,（20.2±3.1）% and（51.1±5.7）%,（60.1±1.1）%）（P〈0.05）.Conclusion Radiofrequency ablation can reverse the structure and function of left atrium and left atrial appendage in patients with non-rheumatic atrial fibrillation.