心房颤动性心肌病导管消融治疗

Progress of catheter ablation in cardiomyopathy induced by atrial fibrillation

心房颤动(房颤)和充血性心力衰竭(心衰)两种疾病常同时存在,且互相产生不利影响,增加了患者心血管事件概率和全因死亡率。房颤导致的心脏扩大、心功能受损称为房颤性心肌病,特点是一旦恢复窦性心律(窦律)或正常心室率后,心脏扩大与心衰能够逆转。治疗上,抗心律失常药物维持窦律远期成功率不足50%,且其不良反应较严重。导管消融术可以根治房颤,恢复窦性节律。理论上,房颤性心肌病患者导管消融术后其心脏结构和功能、生活质量均应明显改善,但这部分人群隐藏在心衰伴房颤的患者中难于被识别,相关研究甚少。目前多数研究是关于多因素导致心衰伴房颤患者的导管消融治疗,术后短期成功率为60～80%,患者心功能及生活质量均得到提高,但远期复发率超过50%。本文对近年来房颤性心肌病的发病机制和导管消融治疗结果的研究加以综述。

Atrial fibrillation（AF）and congestive heart failure（CHF）frequently coexist,and each adversely affects the other,which increases the rates of cardiovascular incidence and all-cause mortality of patients.AF induced cardiac dilatation and function impairment is called AF-induced cardiomyopathy,which is characterized by reversion of heart structure or function after recovering sinus rhythm（SR）or normal heart rate.In therapy,the effectiveness of antiarrhythmic drugs（AADs）for long-term recovery of SR is less than 50%and the side effects cause adverse outcomes.Catheter Ablation（CA）can cure AF,restore SR,without side-effect of AADs.In theory,the structure and function of the heart and quality of life from AF-induced cardiomyopathy should significantly improve in patients after catheter ablation.This group of people is hidden among the patients with HF and AF who are difficult to be identifide,so little is known on CA for them.Now most studies are about CA in patients with heart failure and atrial fibrillation,and the HF are caused by multiple factors.The short-term success rate is 60-80%,the cardiac function and quality of life of patients improve after procedure,but the long-term rate of recurrence is more than 50%.The article summarizes researches on pathogenesis and therapeutic outcome about CA for AF-induced cardiomyopathy for the past few years.