心房颤动患者射频消融术治疗的临床疗效分析

Clinical efficacy of radiofrequency catheter ablation in patients with atrial fibrillation

目的 探讨对有症状性心房颤动（AF）患者行经导管射频消融术（RFCA）治疗的临床疗效。方法 选取2010年4月~2015年6月在新疆医科大学第五附属医院接受RFCA治疗的AF患者100例，其中男性52例，女性48例，年龄18～70岁，平均（54.28±8.31）岁。对比手术前后左心房内径（LAD），左室舒张末内径（LVEDD）和左室收缩末内径（LVESD），左室射血分数（LVEF）及舒张早期二尖瓣血流速度与舒张晚期二尖瓣血流速度比值（E/A），临床治疗效果和并发症发生情况。结果 患者中男性占比52%，平均（54.28±8.31）岁。阵发性AF占62%，AF病程（16.4±6.5）个月。合并高血压占比33%，糖尿病占9%，冠心病占22%，二尖瓣关闭不全占36%。NYHA（纽约心脏病学会心功能分级）Ⅰ级39%，NYHAⅡ级45%，NYHAⅢ级16%。术后LAD（45.19±7.86 mm）明显低于术前（55.78±11.39mm，P＜0.05）；术后和术前LVEF比较差异不显著（P＞0.05）；术后LVEDD（44.13±4.01 mm）明显低于术前（50.62±5.42 mm，P＜0.05）；术后LVESD（27.01±3.71 mm）明显低于术前（32.11±5.30mm，P＜0.05）；术后E/A较术前升高（P＜0.05）。术后1年RFCA治疗成功率为86.00 %（86/100），其中阵发性AF治疗成功率为93.51%（58/62），持续性AF治疗成功率为68.42%（26/38）；复发率为14.00%（14/100），其中阵发性AF复发率为6.45%（4/62），持续性AF治疗成功率为31.58%（12/38）。阵发性AF治疗成功率显著高于持续性AF，复发率显著低于持续性AF（P＜0.05）。并发症发生情况：9例术中或术后出现并发症，7例为阵发性AF患者，2例为持续性AF患者。结论 基于小样本的研究，RFCA治疗有症状AF患者是安全而有效的，但是仍有一定复发率。对于阵发性AF患者应尽早实施RFCA。

Objective To investigate the clinical efficacy of radiofrequency catheter ablation (RFCA) in patientswith atrial fibrillation (AF). Methods AF patients (n=100, male 52, female 48, aged from 18 to 70 and averageage=54.28±8.31) undergone RFCA treatment were chosen from Apr. 2010 to Jun. 2015. The indexes of left atrialdiameter (LAD), left ventricular end-diastolic inner diameter (LVEDd), left ventricular end-systolic diameter (LVESd),left ventricular ejection fraction (LVEF), ratio of left ventricular peak early diastolic mitral flow velocity (E) to latediastole mitral flow velocity (A, E/A), curative effect and incidence of complications were compared before and aftertreatment. Results The percentage of male patients was 52% and average age was (54.28±8.31). The percentage ofpatients with paroxysmal AF was 62% and AF course was (16.4±6.5) m. The percentage of patients with hypertensionwas 33%, diabetes, 9%, coronary heart disease, 22%, and mitral inadequacy, 36%. The percentage of patients with NYHA grade I was 39%, NYHA grade II, 45%, and NYHA grade III, 16%. LAD was significantly lower aftertreatment (45.19±7.86) mm than that before treatment (55.78±11.39) mm (P<0.05). LVEF had no significantdifference before and after the treatment (P>0.05). LVEDd was significantly lower after treatment (44.13±4.01) mmthan that before treatment (50.62±5.42) mm (P<0.05). LVESd was significantly lower after treatment (27.01±3.71)mm than that before treatment (32.11±5.30) mm (P<0.05). E/A increased after the treatment (P<0.05). The totalsuccess rate was 86.00% (86/100) after treatment for 1 y, and success rate for paroxysmal AF was 93.51% (58/62) andfor sustained AF, 68.42% (26/38). The total recurrent rate was 14.00% (14/100), and recurrent rate for paroxysmalAF was 6.45% (4/62) and for sustained AF, 31.58% (12/38). The success rate was significantly higher, and recurrentrate was significantly lower for paroxysmal AF than that for sustained AF (P<0.05). The complications occurred in 9patients during or after treatment, among them 7 with paroxysmal AF and 2 with sustained AF. Conclusion RFCA issafe and effective based on small-sampled study, but recurrent rate is still observed. The patients with paroxysmal AFshould accept RFCA treatment as soon as possible.