导管消融术对老年室性早搏患者心脏舒张功能的影响

Effect of ventricular premature catheter ablation on diastolic function in elderly patients

目的观察导管消融术治疗对老年室性早搏(prematureventricular contraction,PVC)患者心室舒张功能的影响.方法选取2012年3月至2015年5月于河北医科大学第二医院接受导管消融治疗特发性PVC的老年患者(年龄>65岁).术前行心脏超声检查,以舒张早期二尖瓣血流峰速度(E)/舒张早期二尖瓣环速度(e′)代表左室舒张功能,抽取静脉血测量脑钠肽(brain natriureticpeptide,BNP)浓度.所有患者接受三维标测系统指导下的导管消融治疗.术后6个月重复检查心脏超声和BNP浓度,同时复查24 h动态心电图明确PVC情况.结果共有89例接受导管消融的PVC特发性室性早博患者. 6个月时手术成功81例,成功率91.0%.手术成功组术后6个月复查E/e′值(10.2±3.2)较术前(15.3±5.2)明显降低(P<0.001),术后6个月BNP 浓度[(94.0±13.3)pg/L]较术前[(202.0±23.2)pg/L]明显降低(P<0.001).手术未成功组,E/e′值[(16.3±6.3)与(15.2±5.6),P>0.05]和BNP浓度无明显变化[(223.0±26.8)pg/L与(245.0±23.9)pg/L,P>0.05].结论 PVC次数与左室舒张功能相关,室性早搏导管消融术可改善老年PVC患者的左室舒张功能.

Objective To observe whether catheter ablation for ventricular premature complexes (PVC)has an effect on ventricular diastolic function in elderly patients. Methods Elderly patients older than 65 years of age who underwent catheter ablation from March 2012 to May 2015 for idiopathic ventricular premature complexes were enrolled.Preoperative echocardiography was performed using E/e′ for left ventricular diastolic function and venous brain natriuretic peptide (BNP)levels were measured.All patients underwent catheter ablation under the guidance of a three-dimensional mapping system.Cardiac ultrasound and BNP levels were repeated 6 months after ablation, and 24-hour electrocardiogram was performed to confirm ventricular premature complexes. Results There were a total of 89 patients with idiopathic ventricular premature complexes (PVC)who underwent catheter ablation.81 cases were successed at 6 months, with a success rate of 91.0%.At 6 months after ablation, the E/e′ values were significantly lower ((15.3±5.2)vs (10.2±3.2),(P<0.001))and BNP levels were significantly lower ((202.0±23.2)pg/L vs (94±13.3)pg/L),(P<0.001). For the unsuccessful subgroup, there was no significant change in E/e′ values (16.3±6.3 vs 15.2±5.6)and BNP levels ((223.0±26.8)pg/L vs (245.0±23.9)pg/L),(P>0.05). Conclusion The number of premature ventricular beats is associated with left ventricular diastolic function, and ventricular premature catheter ablation can improve left ventricular diastolic function in elderly PVC patients.