二维斑点追踪技术评价阵发性心房颤动患者射频消融术前后左心房功能

Assessment of atrial mechanic function and synchrony after pulmonary vein isolation ablation in patients with paroxysmal atrial fibrillation by 2D speckle tracking echocardiography

目的探讨二维斑点追踪技术评价阵发性心房颤动患者射频消融术前后的左房功能的变化。方法选取北部战区总医院心血管内科自2016年12月至2019年2月收治的60例阵发性心房颤动患者为观察组,另选取同期于我院体检的健康人群40例为健康组。分别于消融术前2 d及术后第2天、1个月、6个月,应用常规超声测量左心房最大容积(LAVmax)、左心房最小容积(LAVmin)和左心房收缩期前容量(LAVp),计算左心房总排空分数(LATEF)、主动排空分数(LAAEF)。用体表面积标化LAVmax,得出左心房容积指数(LAVI)。应用二维斑点追踪技术测量左心房心室收缩期峰值应变(LAS-S)及左心房收缩峰值应变(LAS-A)。测量应变达峰值的时间,计算达峰时间标准差(TPSD)。结果与健康组比较,观察组术前左心房前后径(LAD)、LAVI升高,LATEF、LAAEF、左心室射血分数(LVEF)降低,差异有统计学意义(P<0.05)。与健康组比较,观察组术前LAS-S、LAS-A均降低,心室收缩期达峰时间标准差(SDs)、舒张晚期达峰时间标准差(SDa)均增加,差异均有统计学意义(P<0.05)。LAS-S、LAS-A术后第2天较术前降低,术后6个月较术前升高,差异均有统计学意义(P<0.05)。SDs、SDa术后第2天较术前显著增加,术后1个月时降低,术后6个月较术前显著降低,差异均有统计学意义(P<0.05)。结论阵发性心房颤动患者经导管射频消融术前及术后左心房功能降低是暂时的,长期随访会出现心房的逆重构、容积缩小、功能改善。二维斑点追踪技术参数能够评估射频消融术后患者左心房功能逆重塑情况。

Objective To investigate the left atrial function in patients with paroxysmal atrial fibrillation after radiofrequency ablation.Methods The 60 patients with paroxymal atrial fibrillation who were admitted from December 2016 to February 2019 were selected as the observation group,and 40 healthy patients who underwent physical examination during the same period were selected as the healthy group.The maximum left atrial volume(LAVmax),minimum left atrial volume(LAVmin)and presystolic volume of left atrial(LAVp)were measured by conventional ultrasound at 2 days before ablation and 2 days,1 month and 6 months after ablation,respectively,and the total left atrial emptying fractions(LATEF)and active left atrial emptying fractions(LAAEF)were calculated.The left atrial volume index(LAVI)was obtained by standardizing LAVmax with body surface area.The left atrial peak ventricular systolic strain(LAS-S)and left atrial strain during late diastole(LAS-A)were measured by two-dimensional spot tracking technique.The time of strain reaching peak was measured and the standard deviation of strain reaching peak time(TPSD)was calculated.Results Compared with the healthy group,the preoperative left atrial anterior and posterior diameter(LAD)and LAVI in the observation group were increased,while the LATEF,LAAEF and left ventricular ejection fraction(LVEF)were reduced,with statistically significant differences(P<0.05).Compared with the healthy group,the preoperative LAS-S and LAS-A in the observation group were reduced,and the standard deviation of the time to peak strain during ventricular(SDs)and standard deviation of the time to strain during late diastole(SDa)were increased(P<0.05).On the second day after surgery,LAS-S and LAS-A were lower than those before surgery,and 6 months after surgery were higher than those before surgery(P<0.05).On the second day after surgery,SDs and SDa were significantly increased,reduced 1 month after surgery,and significantly reduced 6 months after surgery(P<0.05).Conclusion Paroxymal atrial fibrillation patients experienced an initial impairment in atrial function and synchrony after PVI,with improvement at longer term Patients with paroxysmal atrial fibrillation will experience a temporary decrease in left atrial function before and after transcatheter radiofrequency ablation.The two-dimensional speckle tracking technique can be used to evaluate the reverse remodeling of left atrial function after radiofrequency ablation.